4248 Moonstone Dr - Inspection Formmy ° `la
Residential Sanitary Sewer Service
Compliance Inspection
i 7 ' i )
Date ,4- / /I Ir'
Name j ; ". ,
PID Number
House Number 2 .1- 1 -> z < ')
- Street Name
Alternative Mailing Address
Owner/Occupant Sigrioture
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
GQ No sump pump
r'\
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
I /•(r✓ am
Time 1 • ' pm
Disk
Non - Compliance
O
O
O
O
Service Lateral Inspection Findings
Roots
O
3
1
4" to 6" Transition:
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks 4'
Transition
Length of Service:
Number Discharged
Sump pumps
Foundation drains
Roof drains
Total
Correctly
Incor rectly Unknown
1l
White Copy: Property Owner
Record Number
Entered S. L at
Time 1`�� • __
Phone j r
Inspector S
Obstruction
Unable to push past
feet
Notes r
• ✓
) .3 - (1.4f0
am
pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH