849 Ivy Lane - Inspection FormsEi1 3 o f E
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Residential Sanitary Sewer Service
Compliance lnspection
,-- ) '
Date '"-----/ /7 , ) Time
• ----- 's .7
,...--,
Name ,.. ,.
i / :=2, fli _-'-------/ )k #
s ....... ,-
PID Number
• 1pm
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House Number Street Name
Aker native Mailing Addr ess
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected co
sanitary sewer
O Sump pump properly piped
O No sump pump
Se r vice Lateral inspection Findings
Roots
Poo\PiPe)bints.
Miner‘al eposits
Sag/Pipi, Deflection
/ I
Darrked Pipe *T7
4" to 6" Transition:
White Copy: Piopety Owner
Owner/Occupant Signature
Non
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewe r
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Fagan
Record Number
Transition / / 7-
4 -
4/ •
Time
Phone (-"7.7... J
-"-
For information call 651.470.2788
Obstruction
Unable to push past
feet
Number of stacks Entered S.L. at
•
•
Inspector Signature
Final Cleanout:
o am
O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
. ,
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i --e 4 / .- ro - 7 - 7 , - . ) 7 1 -
2 -
7' .
........
4.
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Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Notes
Total
Unknown
Sump pumps
Foundation drains
Roof drains
Ei1 3 o f E
•
Residential Sanitary Sewer Service
Compliance lnspection
,-- ) '
Date '"-----/ /7 , ) Time
• ----- 's .7
,...--,
Name ,.. ,.
i / :=2, fli _-'-------/ )k #
s ....... ,-
PID Number
• 1pm
/
j
_C.1
House Number Street Name
Aker native Mailing Addr ess
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected co
sanitary sewer
O Sump pump properly piped
O No sump pump
Se r vice Lateral inspection Findings
Roots
Poo\PiPe)bints.
Miner‘al eposits
Sag/Pipi, Deflection
/ I
Darrked Pipe *T7
4" to 6" Transition:
White Copy: Piopety Owner
Owner/Occupant Signature
Non
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewe r
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Fagan
Record Number
Transition / / 7-
4 -
4/ •
Time
Phone (-"7.7... J
-"-
For information call 651.470.2788
Obstruction
Unable to push past
feet
Number of stacks Entered S.L. at
•
•
Inspector Signature
Final Cleanout:
o am
O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
. ,
, 7 1:7 _.--.j „1,---( ' A .„--) 1
G.: i 1„ .,.." ,,
------- / /4* ,(:- / - - i -) r" 7)
I , c I ,--.'"
i --e 4 / .- ro - 7 - 7 , - . ) 7 1 -
2 -
7' .
........
4.
.'
Pink Copy: SEH
Account # 260536
Service Date 08/18/10
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service
T ex ms: Due 9/17/2010
PO #
Camera inspection of sewer line.
Remit To:
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
City of Eagan/City Dept at:
Wayne Schwan
3419 Coachman Pt
Eagan MN 55122
Service At:
David Johnson
849 Ivy Ln
Eagan 1'IN 55123
Job # 215306
Quantity
DUNS #027314893
1
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Invoice #
Date:
Page #
A64169
08/18/10
1 of 1
Unit Price Extended Price Tx
Please pay from this Invoice. Thank You
Amount Due
Amount Paid
$215.00 $215.00
Balance Due $215..00
Invoice # A64169
Date :
08/18/10
Account # 260536
City of Eagan/City Dept at:
$215.00
of E
Residential Sanitary Sewer Seroce
Compliance n pe o
Date `z I / 10
Name
PID Number
House Number
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
No sump pump
Time
Disk #
Alternate Mailing Address
� , \
l 1� 1 . J
`) a., i f �y��lh !? A A
} O er /gccupant S
nw gnature
Service Lateral Inspection Findings
78
4" to 6" Transition:
White Copy: Property Owner
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
Yellow Copy: City of Eagan
Record Number 1 C 0
Obstruction
Length of Service:
Time
Phone
Unable to push past
feet
s
L
Inspector Signature
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
Number of stacks 7 Entered S.L. at 0 Sri
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout: ,
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Number Discharged
Unknown
Notes
Total Correctly Incorrectly
Sump Pumps
� MINI
Foundation Drains
Roof Drains
1/11-
of E
Residential Sanitary Sewer Seroce
Compliance n pe o
Date `z I / 10
Name
PID Number
House Number
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
No sump pump
Time
Disk #
Alternate Mailing Address
� , \
l 1� 1 . J
`) a., i f �y��lh !? A A
} O er /gccupant S
nw gnature
Service Lateral Inspection Findings
78
4" to 6" Transition:
White Copy: Property Owner
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
Yellow Copy: City of Eagan
Record Number 1 C 0
Obstruction
Length of Service:
Time
Phone
Unable to push past
feet
s
L
Inspector Signature
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
Number of stacks 7 Entered S.L. at 0 Sri
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout: ,
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551