4267 Diamond Dr - Inspection FormResidential Sanitary Sewer Service
Compliance Inspection
Time
Date
1 �I
am
� m pm
Name'. 11 /9Disk #I
PID Number
House Number 2 ° )--e2- i Street Name 1 .� I
Alternative MailingAddress
4" to 6"Transition:
' }y \
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
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
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
Record Number
Time
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks Entered S.L.at
Roots
Yellow Copy: City of Eagan
o am
•
• _ O pm
Inspector Signature
For 'information call 651.470.2788
Length of Ser vice: Final Cleanout:
No Access
0 No one in
Access to service
lage5al n)1f j d
0 Inspect
refused
Notes ) /1
I' /
' .. fir; --" -�`=
4
Pink Copy: SE
Number Discharged
Total
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
Residential Sanitary Sewer Service
Compliance Inspection
Time
Date
1 �I
am
� m pm
Name'. 11 /9Disk #I
PID Number
House Number 2 ° )--e2- i Street Name 1 .� I
Alternative MailingAddress
4" to 6"Transition:
' }y \
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
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
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
Record Number
Time
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks Entered S.L.at
Roots
Yellow Copy: City of Eagan
o am
•
• _ O pm
Inspector Signature
For 'information call 651.470.2788
Length of Ser vice: Final Cleanout:
No Access
0 No one in
Access to service
lage5al n)1f j d
0 Inspect
refused
Notes ) /1
I' /
' .. fir; --" -�`=
4
Pink Copy: SE
Residential Sanitary Sewer Service
Compliance aspect
ty of E
Date e / --/ /
Name
PID Number
House Number 4 /0(a -- )
Alternate Mailing Address PhonerJ °
r
Owner /Occupant Signature
For Information call 651.470.2788
Compliance
No foundation drain connection
No roof drain connection
r .
O Sump pit not connected to
sanitary sewer
O Sump Pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
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
Number of stacks
o am
o pm
Street Name
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet
Inspector Signature
Entered S at rscr
No Access
o No one in
O Access to service lateral
needed
o Inspection refused
Final Cleanout:
o am
o pm
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
Total
Correctly Incorrectly Unknown
Notes
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Account # 260536
Service Date 09/27/10
PO #
Camera inspection of sewer line
Description Of Service
Camera inspection of sewer line
Ier ms: Due 10/27/2010
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
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Dawn Stevens
4267 Diamond Dr
Eagan MN 55122
Job # 217345
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
Invoice #
Date:
Page #
A66845
09/27/10
1 of 1
Unit Price Extended Price Tx
Amount Due
Amount Paid
$215.00 $215.00
Balance Due $215.00
Please pay from this Invoice. Ihank You
Invoice if
Date :
A66845
09/27/10
Account 260536
City of Eagan /City Dept at:
$215,00