860 Ivy Lane - Inspection FormsCity Dr Fa in
Residential Sanitary Sever Service
Compliance Inspection
?
Date (M/ / C ei
Name AYeZ,
PID Number
Rouse Number
Alternative MailingAddress
4" to 6 "Transition:
O Street NameL%
White Copy: Property Owner
Time //
Disk #
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
• ▪ O m
1—LL]—L1]
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:
Record Number
Time
O am
•
O Pm
hone
f D /3,/' 2-
-
/', Inspector Signature
For information call 65
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
otes; S•{
ri r
Final Cleanout:
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
` / > ( 7 b , _
/ ./
; --k Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
Foundation drains
Roof drains
City Dr Fa in
Residential Sanitary Sever Service
Compliance Inspection
?
Date (M/ / C ei
Name AYeZ,
PID Number
Rouse Number
Alternative MailingAddress
4" to 6 "Transition:
O Street NameL%
White Copy: Property Owner
Time //
Disk #
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
• ▪ O m
1—LL]—L1]
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:
Record Number
Time
O am
•
O Pm
hone
f D /3,/' 2-
-
/', Inspector Signature
For information call 65
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
otes; S•{
ri r
Final Cleanout:
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
` / > ( 7 b , _
/ ./
; --k Copy: SEH
Account # 260536
City of Eagan/City Dept at
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Camera inspection of sewer line. Pull & reset toilet.
Remit . 1 o:
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
Service Date 09/15/10 PO # Job # 216637
Please Detach and Return with Remittance
Service At:
Marlys Powers
860 Ivy Ln
Eagan MN 55123
Description Of Service Quantity Unit Price Extended Price Tx
Camera inspection of sewer line 1 $215.00 $215.00
DUNS #027314893
Terms: Due 10/15/2010 Please pay from this Invoice Thank You
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Amount Due
Amount Paid
Invoice # A72277
Date: 09/15/10
Page # 1 of 1
Balance Due $215,00
Invoice #
Date :
A72277
09/15/10
Account # 260536
City of Eagan /City Dept at:
$215..00
0
Residential Bahr Sewer Service
Compliance Inspection
Date 1 /4S /
Name
PID Number
House Number
A Iternate Mailing Address
Compliance
No foundation drain connection
r No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump Pump properly piped
No sump pump
Time
dwner /Occupant Signature
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
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
C—
o am
o pm
Street Name
Number of stacks
Yellow Copy: City of Fagan
Length of Service:
Record Number
Obstruction
n Time
Phone
Unable to push past
feet
Inspector Signature
Entered S L. at AECA
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
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551