2066 Jade Lane - Inspection FormsCity of•Capri
Residential Sanitary Sewer Service
Compliance Inspection
Date ° K t/ O2
Name ---fr? fj7rli-4K
PID Number
House Number Street Name
Alternative Mailing Address
J
4" to 6" Transition:
White Copy: Property Owner
4,
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
P Ec No sump pump
• S 'd pm
•
Time
Disk ##
i -[111-LILJ
i
Length of Service:
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
Yellow Copy: City of Eagan
Record Number
Time
Q
Phone ,r.. i��
,, - V
Z`
Owner /Occupant Signature "'`�°�`"'"' ,,/ '; % %inspector Signature
For information call 65 1:470.2788
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks _ Entered S L at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
O am
• O pm
No Access
O No one in
4
Access to service
lateral needed
O Inspection
refused
Fink Copy: SEH
Total
Notes �. r' irr r'
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4/Ai/ 5 ` i 'tC` i/Em i i .1 .S 1
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Number
Dischar
ed
Correctly
Incorrectly
Unknown
Sump pumps
� _
Foundation drains
Roof drains
City of•Capri
Residential Sanitary Sewer Service
Compliance Inspection
Date ° K t/ O2
Name ---fr? fj7rli-4K
PID Number
House Number Street Name
Alternative Mailing Address
J
4" to 6" Transition:
White Copy: Property Owner
4,
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
P Ec No sump pump
• S 'd pm
•
Time
Disk ##
i -[111-LILJ
i
Length of Service:
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
Yellow Copy: City of Eagan
Record Number
Time
Q
Phone ,r.. i��
,, - V
Z`
Owner /Occupant Signature "'`�°�`"'"' ,,/ '; % %inspector Signature
For information call 65 1:470.2788
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks _ Entered S L at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
O am
• O pm
No Access
O No one in
4
Access to service
lateral needed
O Inspection
refused
Fink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Joe Humenansky
2066 Jade Ln
Eagan MN 55122
Service Date 08/25/10
Camera inspection of sewer line.
Description Of Service
Camera inspection of sewer line.
Terms: Due 9/24/2010
PO #
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [
Acct # Exp Date
Name on Card
Signature
Remit Io:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapoils MN 55411
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 -604 -4285 FAX: 612 -822 -5408
FID#27- 1025956
Job # 215444
Quantity
DUNS #027314893
1
Please Detach and Return with Remittance
Invoice #
Date:
Page #
A51157
08/25/10
1 of 1
Unit Price Extended Price Tx
Please pay from this Invoice.. Thank You
Amount Due
Amount Paid
$215.00 $215.00
Balance Due $215,00
Invoice # A51157
Date :
08/25/10
Account # 260536
City of'Eagan/City Dept at:
$215.00
r
R sidentIr i Sanitary Sewer Se ice
.
Compliance Inspection
Date g l r i j0
Name
PID Number
House Number
....4 „-
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
No sump pump
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
White Copy: Property Owner
Time
Disk tf
Owner /Occ/ pant Signature v �°
Service Lateral Inspection Findings
Roots
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
o am
o pm
Street Name
Number of stacks
4" to 6" Transition: ,<; t ength of Service:
Yellow Copy: City of Eagan
Record Number c' ''? -c I))
Time
Alternate Mailing Adclress Phone
r
Inspector Signature
o am
o pm
For Information call 651.470.2788
Obstruction
Unable to push past
feet
Entered S L at
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout: -
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
({
Foundation Drains
j r�' f
Roof Drains
o
(7
r
R sidentIr i Sanitary Sewer Se ice
.
Compliance Inspection
Date g l r i j0
Name
PID Number
House Number
....4 „-
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
No sump pump
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
White Copy: Property Owner
Time
Disk tf
Owner /Occ/ pant Signature v �°
Service Lateral Inspection Findings
Roots
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
o am
o pm
Street Name
Number of stacks
4" to 6" Transition: ,<; t ength of Service:
Yellow Copy: City of Eagan
Record Number c' ''? -c I))
Time
Alternate Mailing Adclress Phone
r
Inspector Signature
o am
o pm
For Information call 651.470.2788
Obstruction
Unable to push past
feet
Entered S L at
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout: -
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551