4296 Sandstone Dr - Inspection Form4 1b 1 .
City pi •hapit
Residential Sanitary Sewer Service
Compliance inspection
Date / -7 -
„„--•
1 t("
7
Name ), 4„-- Disk #
PID Number
House Number Street Name
Alternative Mailing Address
Owner/Occupant 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
Transition
4" to 6" Transition:
White Copy: Pr °per ty Owner
■■■■1•1■11■0
Time „ •
• , pm am
1
Record Number
• %
ime 91( pm
Phone (,"_> ) —
For information call 651 .470.2788
on-Compliance
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
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
Entered S L at
Inspector Signature
Length of Service: Final Cleanout:
„ otes
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Ser vice Lateral Inspection Findings
Roots
Poor Pipe Joints ('/ ) !1;'' 4, ` 2 ? r`i /(' ---) c3 /) -- •' - '72 -. 1
) j.1 ' / r ; - --; i
1 i } \
Mineral Deposits <- ,.''''-') i 7X -'
i , ,,-.- "Th , , , -=.-.
---- , )
Sag/Pipe Deflection ,' )';-. 1 /-
,-------. / ', -1 -LT:.- -. ."''',/_ . ). 4.—'7) 4: .)e. ./. -- M!W - ."
- i 1- I
Damaged Pipe -4, 71 '.....,, (` ,) .<" i i', - 7 4 ", -. [ - 7 "
Pink Copy: SEI-1
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
---
Roof drains
4 1b 1 .
City pi •hapit
Residential Sanitary Sewer Service
Compliance inspection
Date / -7 -
„„--•
1 t("
7
Name ), 4„-- Disk #
PID Number
House Number Street Name
Alternative Mailing Address
Owner/Occupant 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
Transition
4" to 6" Transition:
White Copy: Pr °per ty Owner
■■■■1•1■11■0
Time „ •
• , pm am
1
Record Number
• %
ime 91( pm
Phone (,"_> ) —
For information call 651 .470.2788
on-Compliance
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
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
Entered S L at
Inspector Signature
Length of Service: Final Cleanout:
„ otes
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Ser vice Lateral Inspection Findings
Roots
Poor Pipe Joints ('/ ) !1;'' 4, ` 2 ? r`i /(' ---) c3 /) -- •' - '72 -. 1
) j.1 ' / r ; - --; i
1 i } \
Mineral Deposits <- ,.''''-') i 7X -'
i , ,,-.- "Th , , , -=.-.
---- , )
Sag/Pipe Deflection ,' )';-. 1 /-
,-------. / ', -1 -LT:.- -. ."''',/_ . ). 4.—'7) 4: .)e. ./. -- M!W - ."
- i 1- I
Damaged Pipe -4, 71 '.....,, (` ,) .<" i i', - 7 4 ", -. [ - 7 "
Pink Copy: SEI-1
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service Date 09/15/10
Camera inspection of sewer line. Pull & reset toilet.
Description Of Seivice Quantity Unit Price Extended Price Tx
Camera inspection of sewer line 1 $215.00 $215.00
Ter ms: Due 10/15/2010
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 -604 -4285 FAX: 612-822-5408
FID #27- 1025956
PO # Joh # 216566
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
Remit To:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapoils MN 55411
Seivice At:
Joyce Goetzke
4296 Sandstone Dr
Eagan MN 55122
Please pay from this Invoice, Thank You
Amount Due
Amount Paid
Date :
Invoice # A72278
Date: 09/15/10
Page # 1 of 1
Balance Due $215.,00
Invoice # A72278
09/15/10
Account # 260536
City of Eagan /City Dept at:
$215.00
Residential Sanitary Sewer e
• o pliance Inspection
- Ea
c
Date 9
Name t)—r
PID Number
House Number s . )
Compliance
0 No foundation drain connection
9 No roof drain connection
o Sump pit not connected to
sanitary sewer.`
O Sump Pump properly piped
No sump pump
Roots
._.
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
\ , O)vner /Occupant Signature
Service Lateral Inspection Findings
i ?`'
f' , ,.
Disk #
Non - Compliance
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
Yellow Copy: City of Eagan
Record Number t__
Obstruction
Unable to push past
feet
Length of Service:
Time
Inspector Signature
Entered S L. at
0
Alternate Mailing Address Phone
For Information call 651.470.2788
No Access
O No one in
o Access to service lateral
needed
O Inspection refused
m
Final Cleanout:
o am
o pm
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Number
Correctly
Discharged
Incorrectly Unknown
Notes
'''.K. ., �_ ;.. t l Y-,
;..1. 1,.
r
- H
Total
Sump Pumps
-
F oundation Brains
Roof Drains
- --
Residential Sanitary Sewer e
• o pliance Inspection
- Ea
c
Date 9
Name t)—r
PID Number
House Number s . )
Compliance
0 No foundation drain connection
9 No roof drain connection
o Sump pit not connected to
sanitary sewer.`
O Sump Pump properly piped
No sump pump
Roots
._.
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
\ , O)vner /Occupant Signature
Service Lateral Inspection Findings
i ?`'
f' , ,.
Disk #
Non - Compliance
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
Yellow Copy: City of Eagan
Record Number t__
Obstruction
Unable to push past
feet
Length of Service:
Time
Inspector Signature
Entered S L. at
0
Alternate Mailing Address Phone
For Information call 651.470.2788
No Access
O No one in
o Access to service lateral
needed
O Inspection refused
m
Final Cleanout:
o am
o pm
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551