2082 Carnelian Lane - Inspection FormResidential Sanitary Sewer Service
City of hp Compliance Inspection
Date f" S/ 27 / /o
Name J /A',/ 4/'//9",4. Disk # Number
PID Numbe
House Number
4" to 6 "Transition:
Alternative Mailing Address Phone (3: Z ' "2—
l l 7,
White Copy: Property Owner
• O am
Time 75 • 0 .P, p
OwnerlOccupant Signature
For information call 651.470.2788
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
Service Lateral Inspection Findings
Street Name ( ! e
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
Number of stacks Entered S L. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
/ f ._.inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
O am
•
• o pm
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Cor
Discharged
Incorrectly Unknown
Notes /1 , ! u /e-
n -
/ 41 `,K
Total
Sump pumps
-
Foundation drains
Roof drains
L J IA; r p ,
Residential Sanitary Sewer Service
City of hp Compliance Inspection
Date f" S/ 27 / /o
Name J /A',/ 4/'//9",4. Disk # Number
PID Numbe
House Number
4" to 6 "Transition:
Alternative Mailing Address Phone (3: Z ' "2—
l l 7,
White Copy: Property Owner
• O am
Time 75 • 0 .P, p
OwnerlOccupant Signature
For information call 651.470.2788
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
Service Lateral Inspection Findings
Street Name ( ! e
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
Number of stacks Entered S L. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
/ f ._.inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
O am
•
• o pm
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service Date 08 /13 /10 PO # Job # 215016
Camera inspection of sewer line.
Description Of Service Quantity Unit Price Extended Price Tx
Camera inspection of sewer line 1 $215.00 $215.00
DUNS #027314893
Terms: Due 9/12/2010 Please pay from this Invoice, Ihank You
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Remit To:
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
Please Detach and Return with Remittance
Service At:
Kim Wilharber
2082 Carnelian Ln
Eagan MIN 55122
Amount Due
Amount Paid
Invoice # A65389
Date: 08/13/10
Page # 1 of 1
Balance Due $215.00
Invoice #
Date :
A65389
08/13/10
Account # 260536
City of Eagan /City Dept at:
$215.00
Resicienttal Sanity
Compliance
Cif or Eafta
Sewer Service
rt pection.
Date / I la 1 \ ,
Name
PID Number
House Number
Alternate Mailing Address
Time
r .�,. LL -
Owner /Occupant Signature
Compliance
No foundation drain connection
/ No roof drain connection
r
C Sump pit not connected to
sanitary sewer
Sump Pump properly piped
0 No sump pump
Service Lateral Inspection Findings
Roots 7 .
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
,2f 7
4" to 6" Transition:
White Copy: Property Owner
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
iI
1
Disk #
O am
o pm
Street Name
For Information call 651.470.2788
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Time
Phone
Unable to push past
feet
EnteredS
7cr.
Inspector Signature
o am
O pm
No Access
o No one in
o Access to service lateral
needed
O Inspection refused
Final Cleanout:
Total
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
(
Correctly
ncorrectly
Unknown
Notes
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551