680 Stonewood Rd - Inspection FormsCity of a i
Residential Sanitary Sewer Service
Compliance Inspection
Date C2el / C] / /
Name 661 C/cc / `V = r Disk #
PID Number
House Number Street Name
Alternative Mailing Address
For information call 651
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
Ser vice Lateral Inspection Findings Number• of stacks Entered S. L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Proper ty Owner
jf• J r o am
Time 7 • d o p
!` Owner /6: dupant Signature
1-LLJ-[J
1
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
Time
J e
Phone /. 6 �_
tj[nspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
0 a
• o pm
No Access
O No one in
Access to service .
lateral needed
O Inspection
refused
Pink Copy: SEH
Number: Discharged
Notes ��}}� - -.
/U� ,�C: _ e ,
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/
K - iii "? %/' , `.
\
- j -\- '.---C.,
A-7 -,
Total
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
City of a i
Residential Sanitary Sewer Service
Compliance Inspection
Date C2el / C] / /
Name 661 C/cc / `V = r Disk #
PID Number
House Number Street Name
Alternative Mailing Address
For information call 651
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
Ser vice Lateral Inspection Findings Number• of stacks Entered S. L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Proper ty Owner
jf• J r o am
Time 7 • d o p
!` Owner /6: dupant Signature
1-LLJ-[J
1
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
Time
J e
Phone /. 6 �_
tj[nspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
0 a
• o pm
No Access
O No one in
Access to service .
lateral needed
O Inspection
refused
Pink Copy: SEH
•
•
1 ilit of Eagan,
Residential Saritta Sewer Service
Compliance spe ion
Date / (7 / ()
Name
PID Number
Owner /Occup ASignaLure
White Copy: Property Owner
Time
Disk #
o am
o pm
House Number 'L Street Name
Alternate ailing r`ess Phone
Compliance
No foundation drain connection
Y No roof drain connection
q Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
No sump pump
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
Obstruction
Unable to push past
feet
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
Transition
<=.
4" to 6" Transition:
Number of stacks i Entered S . at \ .,
,m s
Length of Service: S 3
Final Cleanout:
For Information call 651.470.2788
Number Discharged
Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
Record Number 0 / 5 2 3
Notes
Time
Inspector Signature
e, 0 am
0 pm
Pink Copy: Benjamin Franklin Plumbing
651-222-1551
Account # 260536
Service Date 08/17/10
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service
Terms: Due 9/16/2010
PO #
Camera inspection of sewer line.
Remit To:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis 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:
Rick 1 oepfer
680 Stonewood Rd
Eagan MN 55123
Job # 215235
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
Signatur e
Invoice #
Date:
Page #
A64178
08/17/10
1 of 1
Unit Price Extended Price Tx
$215.00 $215.00
Balance Due $215,00
Please pay from this Invoice„ Thank You
Amount Due
Amount Paid
Invoice #
Date :
A64178
08/17/10
Account # 260536
City of Eagan /City Dept at:
$215,00