877 Ivy Lane - Inspection FormsResidential Sanitary Sewer Service
Compliance Inspection
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Date_�._l���
Name , J --o ,
ND Number
Time ) •
) Disk #
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House Number _�Street Name
Alternative MailingAddres �� --- --
or
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V o Owner /Occupant Signature
For information call 651.4702788
Miner aD
Sump pumps
Foundation drains
Roof drains
4" to b" Transition:
Total
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
pump • No O Flexible sump pump piping
■
Service Lateral Inspection Findings
Number of stacks Entered S.L. at
Roots r te^ ) ,;�
Poor' ipejoin'A 1)
Deflection� � ���
osits _
p
Sag /P ip
am
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Damaged Pipe �° z= . f r
Transition ��
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/ y am /f �i
Length of Service:
Incorrectly
Yellow Copy: City of Eagan
White Copy: Propel ry Owner
Record Number
1'ime
•
e
o am
A Pm
Phone -
inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Pink Copy: SEH
(
City of Ea pa
Residential Sanitary Sewer Service
Compliance Inspection
-., f'2 , r
Date ..Y ,1 / ./
Name ..-:�
C- Disk #
PID Number
House Number �`' . Street Name
Alternative Mailing Address
OwnerlOccupant signa ut re
Compliance
O 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
Sag /Pipe Deflection
Damaged Pipe
Transition
White Copy: Property Owner
4" to b" Transition:1'
1 • ,am
Time f y - { ( pm
a ' S
Non - Compliance
Obstruction
O Clear water connections to Unable to push past
sanitary sewer feet
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Yellow Copy: City of Eagan
Record Number
Time __,,_,_ •
Phone
Inspector Signature
O,am
Pm
For information call 651.470.2788
��
Number of stacks Entered S L at? f'' ' e F .,
Roots
Poor Pipe Joints
Mineral Deposits
Length of Service: ,I Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
.!r
1
e
Pink Copy: SEH
Total
Note
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• Nurber•
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
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- ,
Foundation drains
f at
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?
�,J -4., , t
Roof drains
r
(
City of Ea pa
Residential Sanitary Sewer Service
Compliance Inspection
-., f'2 , r
Date ..Y ,1 / ./
Name ..-:�
C- Disk #
PID Number
House Number �`' . Street Name
Alternative Mailing Address
OwnerlOccupant signa ut re
Compliance
O 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
Sag /Pipe Deflection
Damaged Pipe
Transition
White Copy: Property Owner
4" to b" Transition:1'
1 • ,am
Time f y - { ( pm
a ' S
Non - Compliance
Obstruction
O Clear water connections to Unable to push past
sanitary sewer feet
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Yellow Copy: City of Eagan
Record Number
Time __,,_,_ •
Phone
Inspector Signature
O,am
Pm
For information call 651.470.2788
��
Number of stacks Entered S L at? f'' ' e F .,
Roots
Poor Pipe Joints
Mineral Deposits
Length of Service: ,I Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
.!r
1
e
Pink Copy: SEH
of to
Residential Sanitary ry Sewer Se
o ii nspection
Date Il /
Name
PID Number
House Number
No sump pump
Roots
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
t
Alternate Mailing Address
it if/ 4 d .of -/f'
OwneOccup'q'nf S
t
Compliance
No foundation drain connection
(Y.
o Sump pit not connected to
sanitary sewer
O Sump Pump properly piped
No roof drain connection
Service Lateral Inspection Findings
Poor Pipe Joints 1 ,
, k
1
9
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
o am
o pm
Street Name
Number of stacks
,, , Length of Service:
Yellow Copy: City of Fagan
Record Number - + A:A % 4.
Obstruction
Phone
For Information call 651.470/788
Unable to push past
feet
Entered S L at - 17 t ,
Time
Inspector Signature
Final Cleanout:'
o am
O pm
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Total
N otes
1 ? "2
t .,. e ..
0..
)(0 80
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t
i n ,
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
® -
MI-
Foundation Drains
Roof Drains
ril
of to
Residential Sanitary ry Sewer Se
o ii nspection
Date Il /
Name
PID Number
House Number
No sump pump
Roots
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
t
Alternate Mailing Address
it if/ 4 d .of -/f'
OwneOccup'q'nf S
t
Compliance
No foundation drain connection
(Y.
o Sump pit not connected to
sanitary sewer
O Sump Pump properly piped
No roof drain connection
Service Lateral Inspection Findings
Poor Pipe Joints 1 ,
, k
1
9
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
o am
o pm
Street Name
Number of stacks
,, , Length of Service:
Yellow Copy: City of Fagan
Record Number - + A:A % 4.
Obstruction
Phone
For Information call 651.470/788
Unable to push past
feet
Entered S L at - 17 t ,
Time
Inspector Signature
Final Cleanout:'
o am
O pm
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Account # 260536
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 - 604 -4285 FAX: 612-822-5408
FID#27- 1025956
Invoice #
Date:
Page #
A67244
10/01/10
1 of 1
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service Date 10/01 /10 PO # Job # 216091
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service
Camera inspection of sewer line 1 $215.00 $215.00
Terms: Due 10/31/2010
Quantity
DUNS #027314893
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ 1
Acct # Exp Date
Name on Card
Signature
Remit To:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
Service At:
Nancy Lysholnr
877 Ivy Ln
Eagan MN 55123
Unit Price Extended Price Tx
Balance Due $215..00
Please pay f'r om this Invoice. Thank You
Amount Due
Amount Paid
Invoice # A67244
Date :
10/01/10
Account# 260536
City of Eagan /City Dept at:
$215.00