4253 Sandstone Dr - Inspection FormSump pumps
(
Foundation drains
' ,,
Roof drains
Residential Sanitary Sewer Service
Compliance Inspection
Date / Fe/ )(3
Nam
PID Number
House Number ._t Street Name
Alternative Mailing Address
•
For, inforrrnation call 651:470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
Sump pump properly piped
No sump pump
4" to 6" Transition:
White Copy: Property Owner
7 ode I I I am
Time_. • �t pm
i
Disk #
Owner /Occupant Signature
i ( 1'
gy - 7 -
Phone % -:.., �-� __ l' ✓'C
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
rmwmiw i
Service Lateral Inspection Findings Number of stacks Entered S.L.at,
Roots
Poo Pipe /oints
Mine Deposits --� ''' 2 /) "` } - / -7 ,) __ -:- -- r
Sag/ ip Deflection i r' � � ��'! % r` ?� '
D maged Pipe -, l : ' = i ) _..` -.__ ' L /i J,�. % "''
Transition .r 7
Length of Service:
Number Discharged
Total Correctly Incorrectly Unknown
Record Number
am
Time • 4' Pm
Obstruction
Unable to push past
feet
Notes r - /
Inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Chad & Shawna Peterson
4253 Sandstone Di
Eagan MN 55122
Service Date 09/15/10
PO #
Camera inspection of sewer line.
Description Of Service
Camera inspection of sewer line.
1
Remit Io:
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 #2'7- 1025956
Job # 216834
Quantity
DUNS #027314893
Ter ms: Due 10/15/2010 Please pay from this Invoice. Thank You
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Unit Price
$215.00
Amount Due
Amount Paid
Balance Due
Date :
Invoice #
Date:
Page #
A72275
09/15/10
1 of 1
Extended Price Tx
$215.00
$215.,00
Invoice # A72275
09/15/10
Account 260536
City of Eagan /City Dept at:
$215.00
Residential San a Sewer Service
Compliance nspection
o
Date f
Name
PID Number
House Number
2105
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
Time
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Disk #
o am
o pm
Street Name
Alternate Mailing A ddress
Owner /Occupant Signature
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
Length of Service:
Yellow Copy: City of Eagan
Record Number e9i
Obstruction
Unable to push past
feet
Time
Phone
Inspector Signature
For Information call 651.470.2788
Number of stacks Entered 5 L at
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
1
4
L
Correctly Incorrectly Unknown
Notes
k t
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551