865 Ivy Lane - Inspection FormsCity oi Irapa .
Residential Sanitary Sewer Service
Compliance Inspection
Date
r;)
Name ; 1 ' f47-7 / /Pp./Disk #
PID Number
House Number " 3 Street Name
Alternative Mailing Address
i
/
•
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
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Pr Owner
Cram
Time �� • � 'p pm
Owner /Occupant Signature
- LL1 -[1J
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
Record Number
Time
Phone% i .. � �2' -
. 1
Irpector Signature
For information call 65
Obstruction
Unable to push past
feet
Number of stacks Entered S.L at
Length of Service: Final Cleanout:
® O am
• O pm
No Access
0 No one in
pg{ Access to service
lateral needed
0 Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Notes ----°
(
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
City oi Irapa .
Residential Sanitary Sewer Service
Compliance Inspection
Date
r;)
Name ; 1 ' f47-7 / /Pp./Disk #
PID Number
House Number " 3 Street Name
Alternative Mailing Address
i
/
•
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
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Pr Owner
Cram
Time �� • � 'p pm
Owner /Occupant Signature
- LL1 -[1J
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
Record Number
Time
Phone% i .. � �2' -
. 1
Irpector Signature
For information call 65
Obstruction
Unable to push past
feet
Number of stacks Entered S.L at
Length of Service: Final Cleanout:
® O am
• O pm
No Access
0 No one in
pg{ Access to service
lateral needed
0 Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Notes ----°
(
Yellow Copy: City of Eagan Pink Copy: SEH
Account # 260536
Service Date 08/31/10
Camera inspection of sewer line.
Description Of Service
PO #
Camera inspection of sewer line
Terms: Due 9/30/2010
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 Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Kathy Ameluxen
865 Ivy Ln
Eagan MN 55123
Job # 215807
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 #
A63736
08/31/10
1 of 1
Unit Price Extended Price Tx
Amount Due
Amount Paid
$215.00 $215.00
Balance Due $215.00
Please pay from this Invoice. Thank You
Invoice #
Date
A63736
08/31/10
Account # 260536
City of Eagan /City Dept at:
$215,00
City o lava
Resideritt'al Sartitary Sewer Service
onpi an ce Inspection
Date .$? /
Name
r ,_ r
PID Number
i.?
House Number (9
;, .1
Owner /Occupant Signature
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
4” to 6" Transition: t O/t
White Copy: Property Owner
Time
1 r i
Disk #
T`ifs� i.'1
o am
0 pm
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
Street Name
Record Number
Time
"nspector Signature
o am
o pm
Alternate Address Phone 1 - - ;; °; ., .r 7, 2
For Information call 651.470.2788
Number of stacks Entered S L. at
Length of Service:
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe E -
Transition
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Total
N otes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
Foundation Drains
Roof Drains
u.
City o lava
Resideritt'al Sartitary Sewer Service
onpi an ce Inspection
Date .$? /
Name
r ,_ r
PID Number
i.?
House Number (9
;, .1
Owner /Occupant Signature
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
4” to 6" Transition: t O/t
White Copy: Property Owner
Time
1 r i
Disk #
T`ifs� i.'1
o am
0 pm
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
Street Name
Record Number
Time
"nspector Signature
o am
o pm
Alternate Address Phone 1 - - ;; °; ., .r 7, 2
For Information call 651.470.2788
Number of stacks Entered S L. at
Length of Service:
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe E -
Transition
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551