808 Ivy Lane - Inspection FormCity of o
Residential Sanitary Sewer Service
Compliance Inspection
Date /
I(7 • l `
Nam
PID Number
I -louse Number.
Alternative Mailing Address
!'„,f
j _;�OwnerlOccupant Signature
For information call 651.470.2788
Non - Compliance
No foundation drain connection 0 Clear water connections to
Compliance
0
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: Proper ty Owner
r%
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
am
Time / • o pm
Disk #
Street Name
� -CL1
1
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks
f �y
Damaged Pipe
Length of Service:
Yellow Copy: City of Eagan
Record Number 7
_
Notes
Time
Obstruction
Unable to push past
feet
Entered S L at
Inspector Signature
Final Cleanout:
o am
•
• o pm
Phone r�'_ -___� - �.!>
No Access
0 No one in
Access to service
lateral rje ed r
0 Inspeeti - '
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Total
Sump pumps
Foundation drains
Roof drains
City of o
Residential Sanitary Sewer Service
Compliance Inspection
Date /
I(7 • l `
Nam
PID Number
I -louse Number.
Alternative Mailing Address
!'„,f
j _;�OwnerlOccupant Signature
For information call 651.470.2788
Non - Compliance
No foundation drain connection 0 Clear water connections to
Compliance
0
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: Proper ty Owner
r%
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
am
Time / • o pm
Disk #
Street Name
� -CL1
1
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks
f �y
Damaged Pipe
Length of Service:
Yellow Copy: City of Eagan
Record Number 7
_
Notes
Time
Obstruction
Unable to push past
feet
Entered S L at
Inspector Signature
Final Cleanout:
o am
•
• o pm
Phone r�'_ -___� - �.!>
No Access
0 No one in
Access to service
lateral rje ed r
0 Inspeeti - '
refused
Pink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwarz
3419 Coachman Pt.
Eagan MN 55122
Service At:
Corinne Young
808 Ivy Ln
Eagan MN 55123
Service Date 08/09/10
Description Of Service
PO #
Camera inspection of sewer line. Pull & reset toilet.
Camera inspection of sewer line
Remit I o:
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
Job # 214668
Quantity
1
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Amount Due
Amount Paid
Invoice #
Date:
Page #
A22802
08/09/10
1of1
Unit Price Extended Price Tx
$215.00 $215.00
Balance Due $215,00
DUNS #027314893
Terms: Due 9/8/2010 Please pay from this Invoice. Thank You
Invoice # A22802
Date : 08/09/10
Account # 2605361
City of Eagan /City Dept at:
$215
Residential Sanitary Sewer Service
Compliance Inspection
n
j Cif of a an
Date = /
Name
PID Number
House Number
No roof drain connection
Transition
, 1
White Copy: Property Owner
r
Owner Occuparif
Compliance
,o\ No foundation drain connection
i,.
1Q
O Sump pit not connected to
sanitary sewer
o� Sump Pump properly piped
0 No sump pump
Time
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
4" to 6" Transition:
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
Street Name
Alternate Mailing Address Phone C-
' �
For Information can 651.470.2788
Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number
Obstruction
-
Unable to push past
feet.
Time
Inspector Signature
Entered S L at
•
o am
o pm
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout: ,
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Total
N otes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
(_/--)
=I
Foundation Drains
i' ,
_ -
Roof Drains
�
(
Residential Sanitary Sewer Service
Compliance Inspection
n
j Cif of a an
Date = /
Name
PID Number
House Number
No roof drain connection
Transition
, 1
White Copy: Property Owner
r
Owner Occuparif
Compliance
,o\ No foundation drain connection
i,.
1Q
O Sump pit not connected to
sanitary sewer
o� Sump Pump properly piped
0 No sump pump
Time
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
4" to 6" Transition:
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
Street Name
Alternate Mailing Address Phone C-
' �
For Information can 651.470.2788
Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number
Obstruction
-
Unable to push past
feet.
Time
Inspector Signature
Entered S L at
•
o am
o pm
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout: ,
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551