4266 Moonstone Dr - Inspection FormResident
al Sanitary Sewer Service
•
Compliance Inspection
Date / . 0 (JO Jam Time
Disk##
p/ Number
J / 1 j
-louse Number
- _ --, 'Street Na �--.
Alternative Mailing
g Address
Phone; _ - p! 2 7 7.7
Compliance
0 No foundation drain connection
No roof drain connection
O , Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Mineral Deposits
5er vice Lat al !n e
_vP cti Findin Jg 5, Number I
Dots r of stacks . Entered S L at
'ump pumps
Dundation drains
)of drains
Owner /Occupant .Signature
No n - Compliance
Clear water connectio ns
sanitary sewer ° to C )
0 Service lateral defec
Defective manholes
Sump pump connected to s
sewer �`` -
O Flexible .. ; �"
amp mp p ump piping
-Vhite Copy: Property Owner
Nu
R J
Poor Pipefoints
Damaged Pipe
Sag /Pipe Deflection
'Transition ---77;
ransition � ; f €`� 7)
d c , �� —�)
I f 7
4 to 6" Transition: "-
nsition:
Length of Service:
Final Cleanout:
Yellow Copy City of Eagan
o f_
Inspector Signature
C - -1
Record Number
0- Time
Obstruction
Unable to push past
feet
zF<;. •
Notes
am
pm
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Pink Copy SE}
;r
_
k C opy:
l /.
te_/ / / 1 1 3 Time
Name ) _ / I �•�� , P Disk #,
PID Number
House Number
Alternative Mailing Address
Tra sition
Residential Sanitary Sewer Service
White Copy: Property Owner
f�° f Street Name
Phone l2=
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 " Transition: 41-1)/(5710 2
T -.
o am
O pm
For information call 65
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Lateral Inspe tion Findings Number of tacks Entered S. L. at
Poor ipe j ' ints .. 'v) ! f /tJ J <-----,-, , ‹.-7r.:1-4.,- `` - .a!� „ %
Miner IDeposi ='�i �7(7 - 71 ' ,.
Sag /Pip
Deflection -� , �__.� -. ,�_ � �.- � � a
I 1.
Dam g Pipe r7 . ls� ��� ,i , �✓
Lg ngth of Service:
Yellow Copy: City of Eagan
Record Number
- Time
Obstruction
Unable to push past
feet
Inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
Pink Copy: SEH
Total
/ / ._
, -
Number
o .;�
` ` � AI
0.0
Discharged
•Incorrectly
.Gi/ Aflr
i 004
nknown
-SIC .
i / *
Notes
- .4« --7,1--_, / 9
C- i /}`-" �}
/} G' /f e ji . _ �
� "-' fi'' / / t ! � -
Su p pump
.
Faun' Ion drains
of drains
l /.
te_/ / / 1 1 3 Time
Name ) _ / I �•�� , P Disk #,
PID Number
House Number
Alternative Mailing Address
Tra sition
Residential Sanitary Sewer Service
White Copy: Property Owner
f�° f Street Name
Phone l2=
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 " Transition: 41-1)/(5710 2
T -.
o am
O pm
For information call 65
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Lateral Inspe tion Findings Number of tacks Entered S. L. at
Poor ipe j ' ints .. 'v) ! f /tJ J <-----,-, , ‹.-7r.:1-4.,- `` - .a!� „ %
Miner IDeposi ='�i �7(7 - 71 ' ,.
Sag /Pip
Deflection -� , �__.� -. ,�_ � �.- � � a
I 1.
Dam g Pipe r7 . ls� ��� ,i , �✓
Lg ngth of Service:
Yellow Copy: City of Eagan
Record Number
- Time
Obstruction
Unable to push past
feet
Inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
Pink Copy: SEH