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877 Ivy Lane - Inspection FormsResidential Sanitary Sewer Service Compliance Inspection ) Date_�._l��� Name , J --o , ND Number Time ) • ) Disk # — — House Number _�Street Name Alternative MailingAddres �� --- -- or r 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 LtJ-DJ i Damaged Pipe �° z= . f r Transition �� ;l / 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 '' , J r� . „,, - y r �_. .) $ %-" ; r A . - 1 `'y t� -,~ d j ,, ;v ) CJ • Nurber• Discharged Correctly Incorrectly Unknown Sump pumps / - , Foundation drains f at � . ? �,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 �€rr� 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