4347 Jasper Dr - Inspection FormCity n1 Eapn
Residential Sanitary Sewer Service
Compliance Inspection
Date 07 f / :I 1a
Name „m /viet. k €L.
PID Number _
House Number
Alternative Mailing Address
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:
White Copy: Property Owner
Time d7 : 00 o pm
Disk #
Lf4/ 7 Street Name
OwnerlOccupant Signature
For information call 651.470.2788
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Sump pumps
Foundation drains
Roof drains
Total
J-CE
17-IfigE. „of
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
Length of Service:
Number Discharged
Correctly
Incorrectly
Unknown
Record Number
[ ,M
Phope
z/ s2
f
v :/ /7 7' Inspector Signature
Obstruction
Unable to push past
feet
Entered S.L at
• O am
O O Pm
/ ,12
Final Cleanout:
Notes pA , )
c' rf
Yellow Copy: City of Eagan
- � ion ( /
No Access
O No one in
IV W
r
Gtr
Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
L - 4 r'
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Camera inspection of sewer line,
Description Of Service
Ter ms: Due 9/16/2010
Remit To:
Benjamin Fr anklin 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
Service Date 08/17/10 PO # Tob # 215233
Quantity
DUNS #027314893
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Service At:
Sharon Carl
4347 Jasper Dr
Eagan MN 55122
Amount Due
Amount Paid
Invoice #
Date :
Invoice #
Date:
Page #
A64177
08/17/10
1 of 1
Unit Pr ice Extended Price Tx
Camera inspection of sewer line. 1 $215.00 $215.00
Balance Due $215.,00
Please pay from this Invoice. Thank You
A64177
08/17/10
Account # 260536
City of Eagan /City Dept at:
8215.00
eai nt a Sanitary Sower SeiT
- itance Inspection.
ice
•
Date / 1 1
Name c,
P]D Number
Time
cr
Alternate Mailing Address
Owner /Occupant Signature
Compliance
No foundation drain connection
No roof drain connection
o Sump pit not connected to
sanitary sewer
O Sump Pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots i/. ,951 r
C C
Poor Pipe Joints ! f, 3) ,
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
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
o am
O pm
House Number 4311 Street Name 73, s :'
For Information call 651.470.2788
Yellow Copy: City of Eagan
Record Number 49/ 5� 3 3
Obstruction
Unable to push past
feet
Length of Service: G
Time
o am
o pm
Phone 661- 1 1S1.9 -- ► 9 3 3
Inspector Signature
No Access
O No one in
o Access to service lateral
needed
o Inspection refused
Number of stacks Entered S.L at C. i
Final Cleanout:
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
Total Correctly Incorrectly Unknown
Notes
C.
Pink Copy: Benjamin Franklin Plumbing
651 -222 -1551