2054 Carnelian Lane - Inspection Form! 3
City o
Residential Sanitary Sewer Service
Compliance Inspection
Dated ix / / l 1 Time
Name
TT 72,
PID Number
House Number „<'°,7,,,),)-) 4 Street Name
Alternative Mailing Address
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump property piped
O No sump pump
/ Disk #. rjj
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Pro perty Owner
• % am
!O pm
Non - Compliance
O
O
O
O
O
LLJ-W
Length of Service:
Yellow Copy: City of Eagan
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Record Number
Time
Number of stacks _ Entered S L at
Obstruction
Unable to push past
feet
Phone _ 6. .7 ^.�' > .._
Inspector Signature
For information call 651.470.2788
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
•
• __ O pm
No Access
0 No one in
C'
0 am
Access to service
_Laval need
0 inspection
r efused
Pink Copy: SEH
C L)
ri
Number Discharged
ote5
,:
) 1 ! � t %L
'-fir .,L -4-T ( , l '.) -: � ,,,
, ._ ,. --' ' -_ ,L j
Total
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
! 3
City o
Residential Sanitary Sewer Service
Compliance Inspection
Dated ix / / l 1 Time
Name
TT 72,
PID Number
House Number „<'°,7,,,),)-) 4 Street Name
Alternative Mailing Address
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump property piped
O No sump pump
/ Disk #. rjj
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Pro perty Owner
• % am
!O pm
Non - Compliance
O
O
O
O
O
LLJ-W
Length of Service:
Yellow Copy: City of Eagan
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Record Number
Time
Number of stacks _ Entered S L at
Obstruction
Unable to push past
feet
Phone _ 6. .7 ^.�' > .._
Inspector Signature
For information call 651.470.2788
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
•
• __ O pm
No Access
0 No one in
C'
0 am
Access to service
_Laval need
0 inspection
r efused
Pink Copy: SEH
C L)
ri
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Jett Olsen
2054 Carnelian Ln
Eagan MN 55122
Service Date 08/12/10
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service
Camera inspection of sewer line
Terms: Due 9/11/2010
PO #
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 -604 -4285 FAX: 612-822-5408
FID #27- 1025956
Job # 214763
Quantity
DUNS #027314893
1
Please Detach and Return with Remittance
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
Minneapolis MN 55411
Invoice # A65393
Date: 08/12/10
Page # 1 of 1
Unit Pr ice Extended Price Tx
$215.00 $215.00
Please pay front this Invoice. Thank You
Amount Due
Amount Paid
Balance Due $215,00
Invoice #
Date :
A65393
08/12/10
Account # 260536
City of Eagan/City Dept at:
$215,00
Residential Sanitary .ewer Se, ce
Compliance Inspection
City er Ewa
Compliance
No foundation drain connection
%. No roof drain connection
Sump pit not connected to
sanitary sewer
o Sump Pump properly piped
Date 5 1 ! 1 10
No sump pump
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
Name 3rc-c ri)A �^
PID Number �7
Rouse Number ✓ S El
Alternate Mailing Address
/ Owner /Occupant Signature
Service Lateral Inspection Findings
am
[: 0 pm
Disk #
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
Street Name
Number of stacks
Length of Service:
Sump Pumps
Foundation Drains
Roof Drains
Total
Correctly incorrectly Unknown
� �r7C
Record Number
Obstruction
Notes
Time
Unable to push past
feet
Phone C-
Inspector Signature
O am
o pm
For information call 651.470.2788
No Access
O No one in
o Access to service lateral
needed
O Inspection refused
Entered S L. at ° L. 5
Roots
�� 3 43 . C-3 ;,2 I# -7 0
Poor Pipe Joints J
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Final Cieanout: l c
Yellow Copy: City of Eagan Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551