3797 South Hills Cir - Inspection Form44111
Cit y or Ca afl
Residential Sanitary Sewer Service
Compliance Inspection
Date al / /o
Name n Disk #
PID Number
House Number'
Alternative Mailing Address
For information call 651.470.2788
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
Service Lateral Inspection Findings
Roots
Transition
4" to 6" Transition:
White Copy: Property Owner
�/•
Time /,s e pam am
Street Name
0wnerl0ccupant Signature
Non - Compliance
0
0
O
0
0
Clear water connections to
sanitary sewer.
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number
Time
o am
•
• o pm
- Inspector Signature
Obstruction
Unable to push past
feet
Entered S L at
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
r)AJ V 4- of
Final Cleanout:
_ / V •
No Access
O No one in
Notes AL
1/ t ] 1 rI r" ./ice fr(
A l Access to service
lateral needed
O Inspection
refused
i Jv G VV 1 Cl(
Pink Copy: SEH
Number
Correctly
Discharged
lncorrectly
Unknown
Total
Sump pumps
Foundation drains
Roof drains
44111
Cit y or Ca afl
Residential Sanitary Sewer Service
Compliance Inspection
Date al / /o
Name n Disk #
PID Number
House Number'
Alternative Mailing Address
For information call 651.470.2788
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
Service Lateral Inspection Findings
Roots
Transition
4" to 6" Transition:
White Copy: Property Owner
�/•
Time /,s e pam am
Street Name
0wnerl0ccupant Signature
Non - Compliance
0
0
O
0
0
Clear water connections to
sanitary sewer.
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number
Time
o am
•
• o pm
- Inspector Signature
Obstruction
Unable to push past
feet
Entered S L at
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
r)AJ V 4- of
Final Cleanout:
_ / V •
No Access
O No one in
Notes AL
1/ t ] 1 rI r" ./ice fr(
A l Access to service
lateral needed
O Inspection
refused
i Jv G VV 1 Cl(
Pink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt.
Eagan MN 55122
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 - 604 -4285 FAX: 612-822-5408
FID #27- 1025956
Service Date 08/11/10 PO # lob # 214850
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service Quantity Unit Price Extended Price Tx
Camera inspection of sewer. line 1 $215.00 $215.00
DUNS #027314893
Ierms: Due 9/10/2010 Please pay from this Invoice„ Ihank You
Remit To:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Service At:
Wallace Peterson
3797 South Hills Cit
Eagan MN 55123
Amount Due
Amount Paid
Balance Due $215.00
Invoice # A65397
Date :
Invoice # A65397
Date: 08/11/10
Page # 1 of 1
08/11/10
Account # 260536
City of Eagan /City Dept at:
$215.00
City of Eagan
Residential Sanitary Sewer Se r
Compliance Inspection
Date
Name
PID Number
House Number
Transition
3 - 79 - 7
White Copy: Property Owner
Time
- y Disk #
Owner /Occupant Signature
Compliance
0 No foundation drain connection
o No roof drain connection
0\ Sump pit not connected to
sanitary sewer
Sump Pump properly piped
No sump pump
5_ 5
4" to 6" Transition:
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 Eagan
Record Number 67
Alternate Mailing Address
Obstruction
Time
i �S
Phone
Unable to push past
5 feet
r
Inspector Signature
Entered S L at
J C?
Final Cleanout: -5
O am
O pm
For Information call 651.470.2788
No Access
o No one in
O Access to service lateral
needed
O Inspection refused
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
Total
Correctly Incorrectly Unknown
Notes (
Cc..x r
ti) _ c, ry,,
A r > i
C
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551