866 Ivy Lane - Inspection FormsEapa
Residential Sanitary Sewer Service
Compliance Inspection
Date: I l / : Time
Alternative Mailing Address
4" to 6 "Transition:
Owner /Occupant Signature
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
/(f'. O. am
' f N Cepm
Disk #
PID Number
House Number 4 n (Th Street Name _
For information call 651.470.2788
Non - Compliance
O
O
O
O
O
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Ser vice:
White Copy: Property Owner
Yellow Copy: City of Eagan
Record Number
Phon` „<ec7) ,O /9'� e ?/' /7,
_____p_____ 1 ewi`/ ///
"'✓ Inspeitor Signature
Obstruction
Unable to push past
feet
Entered S L at
Notes --A U Ts TO .S C
Time
Final Cleanout:
o am
•
B O pm
L C - .._ M / _sM
No Access
O No one in
r Access to service .
lateral needed
O Inspection
r efused
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
Eapa
Residential Sanitary Sewer Service
Compliance Inspection
Date: I l / : Time
Alternative Mailing Address
4" to 6 "Transition:
Owner /Occupant Signature
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
/(f'. O. am
' f N Cepm
Disk #
PID Number
House Number 4 n (Th Street Name _
For information call 651.470.2788
Non - Compliance
O
O
O
O
O
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Ser vice:
White Copy: Property Owner
Yellow Copy: City of Eagan
Record Number
Phon` „<ec7) ,O /9'� e ?/' /7,
_____p_____ 1 ewi`/ ///
"'✓ Inspeitor Signature
Obstruction
Unable to push past
feet
Entered S L at
Notes --A U Ts TO .S C
Time
Final Cleanout:
o am
•
B O pm
L C - .._ M / _sM
No Access
O No one in
r Access to service .
lateral needed
O Inspection
r efused
Pink Copy: SEH
Account# 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Janine Dehn
866 Ivy LN
Eagan MN 55123
Service Date 09/23/10
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service
PO #
Camera inspection of sewer line
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 -604 -4285 FAX: 612 -822 -5408
FID #27- 1025956
Job # 217152
Quantity
1
DUNS #027314893
Terms: Due 10/23/2010 Please pay f'r om this Invoice„ Thank You
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Remit To:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapoils MN 55411
Invoice #
Date:
Page #
A66837
09/23/10
1 of 1
Unit Price Extended Price Tx
Amount Due
Amount Paid
8215.00 $215.00
Balance Due 8215.00
Invoice # A66837
Date :
09/23/10
Account # 260536
City of Eagan /City Dept at:
8215 .00
Residential Sanitary Sewer service
City o Ea
Compliance Inspection
Date 03
Name
PID Number
House Number
Alternate Mailing Address j
Compliance
• -.No foundation drain connection
& No roof drain connection
Sump pit not connected to
sanitary sewer
Sump Pump properly piped
o No sump pump
Time
Owner /Occupant Signature
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection :' }i 7 S
Damaged Pipe 7;7
Transition
4" to 6" Transition: } 4
White Copy: Property Owner
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
Yellow Copy: City of Eagan
Record Number �! / < 7
Obstruction
Length of Service: 1Jr
1 1
Time
Phone
Unable to push past
feet
Inspector Signature
Final Cleanout:t 1
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 0 Entered S . at I 1-11 . s ° -. :1..4'°
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
1
Foundation Drains
Roof Drains
Residential Sanitary Sewer service
City o Ea
Compliance Inspection
Date 03
Name
PID Number
House Number
Alternate Mailing Address j
Compliance
• -.No foundation drain connection
& No roof drain connection
Sump pit not connected to
sanitary sewer
Sump Pump properly piped
o No sump pump
Time
Owner /Occupant Signature
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection :' }i 7 S
Damaged Pipe 7;7
Transition
4" to 6" Transition: } 4
White Copy: Property Owner
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
Yellow Copy: City of Eagan
Record Number �! / < 7
Obstruction
Length of Service: 1Jr
1 1
Time
Phone
Unable to push past
feet
Inspector Signature
Final Cleanout:t 1
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 0 Entered S . at I 1-11 . s ° -. :1..4'°
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551