822 Wescott Square - Inspection FormCity of taps
Residential Sanitary Sewer Service
Compliance Inspection
Date4 . ! /U
Name / l "
� %� ✓; ' Disk# 1—
PLD Number. I I
House Number
4" to 6 "Transition:
X22
Alternative Mailing Address
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
Roots
White Copy: Property Owner
p am
Time > �► 2 0 o pm
OwnerlOccupant Signature
Street Name
Length of Service:
Phone
z7 (7Y T o .�
/i
For information call 651.474.2788
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
Number of stacks
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan
Record Number
Time
Inspector Signature
Obstruction
Unable to push past
feet
Entered S L at
Notes --' /14
Final Cleanout:
1
• O am
o O pm
No Access
Q No one in
O Inspection
refused
O Access to service .
lateral needed
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
Foundation drains
Roof drains
City of taps
Residential Sanitary Sewer Service
Compliance Inspection
Date4 . ! /U
Name / l "
� %� ✓; ' Disk# 1—
PLD Number. I I
House Number
4" to 6 "Transition:
X22
Alternative Mailing Address
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
Roots
White Copy: Property Owner
p am
Time > �► 2 0 o pm
OwnerlOccupant Signature
Street Name
Length of Service:
Phone
z7 (7Y T o .�
/i
For information call 651.474.2788
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
Number of stacks
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan
Record Number
Time
Inspector Signature
Obstruction
Unable to push past
feet
Entered S L at
Notes --' /14
Final Cleanout:
1
• O am
o O pm
No Access
Q No one in
O Inspection
refused
O Access to service .
lateral needed
Pink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt.
Eagan MN 55122
Camera inspection of sewer line.
Terms: Due 10/3/2010
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
Service Date 09/03/10 PO # Job # 216133
Description Of Service Quantity Unit Pr ice Extended Price Tx
Camera inspection of sewer line 1 $215.00 $215.00
DUNS #027314893
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [
Acct # Exp Date
Name on Card
Signature
Service At:
Shayna Schwach
822 Westcott Sq
Eagan MN 55123
Invoice # A65526
Date: 09/03/10
Page # 1 of 1
Balance Due $215.00
Please pay it om this Invoice. Ihank You
Amount Due
Amount Paid
Invoice #
Date :
A65526
09/03/10
Account # 260536
City of Eagan /City Dept at:
$215..00
Ewa
:c,s cnUUa l ._Sanitary. Sewer Sic
cccc inspection
Date —;I $ I
0
Name . n. „er.,
PID Number
House Number
Mailing Address
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
p No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints U
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
i`
White Copy: Property Owner
Time
4" to 6" Transition:
Disk #
0 am
OY pm
For Information call 651.470.2788
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Inspector Signature
Obstruction
Unable to push past
feet
Entered S L at . rCe
Time
Final Cleanout
o am
O pm
Phone l -
No Access
O No one in
O Access to service lateral
needed
O Inspection refused
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Total
N otes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
0
---
-M-
ME
Foundation Drains
0
Roof Drains
EI
Ewa
:c,s cnUUa l ._Sanitary. Sewer Sic
cccc inspection
Date —;I $ I
0
Name . n. „er.,
PID Number
House Number
Mailing Address
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
p No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints U
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
i`
White Copy: Property Owner
Time
4" to 6" Transition:
Disk #
0 am
OY pm
For Information call 651.470.2788
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Inspector Signature
Obstruction
Unable to push past
feet
Entered S L at . rCe
Time
Final Cleanout
o am
O pm
Phone l -
No Access
O No one in
O Access to service lateral
needed
O Inspection refused
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551