804 Ivy Lane - Inspection FormCity al talan
Residential Sanitary Sewer Service
Compliance Inspection
Name ( - 22 , 1 ?- 4 1
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
4" to 6"Transition:
White Copy: Property Owner
Time •V bpm
Disk #
PID Number
House Number Street Name Z/ I
OwnerlOccupant Signature
For information call 651.470.2788
Non-Compliance
0
0
0
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 Service:
Number Discharged
Record Number
Time
Phone /(7: (_36"
71
inspector Signature
Obstruction
Unable to push past
feet.
Entered S.L.at
Final Cleanout:
0 am
•
• 0 pm
/
72' /
( '
No Access
O .No one-
in
/ 7
--Access to service
lateral needed
r•
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Betty Olsen
804 Ivy Ln
Eagan MN 55123
Service Date 09/09/10
Camera inspectin of sewer line. Pull & reset toilet.
Description Of Service
PO #
Camera inspectin of sewer line
Invoice
Benjamin Franklin Plumbing
1424 3rd StN
Minneapolis MN 55411
612 -604 -4285 FAX: 612 -822 -5408
FID #27- 1025956
Job # 216217
Quantity
1
DUNS #027314893
Terms: Due 10/9/2011.1 Please pay from 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
Amount Due
Amount Paid
Invoice #
Date:
Page #
Invoice #
Date :
A71909
09/09/10
1 of 1
Unit Price Extended Price Tx
$215.00 $215.00
Balance Due $215.00
A71909
09/09/10
Account 260536
City of Eagan /City Dept at:
$215.,00
eskl nUUai Sanitary Sewer Berke
Compliance Inspection
Rapt
Date 1 /
Name
PID Number
House Number
Alternate Mailing Address
White Copy: Property Owner
Time
Disk #
Owner /Occupant Signature
o am
O pm
Street Name
Yellow Copy: City of Eagan
Record Number
Time
Phone .
Inspector Signature
o am
o pm
Compliance
gi Oil" No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
o 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 e'
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Number of stacks Entered S.L at i _. * :.. °•1 per: <;
Length of Service:
Final Cleanout:
For Information call 651.470.2788
Pink Copy: Benjamin Franklin Plumbing
651 -222 -1551
Total
N otes
-% (:
r,,,,. ?
t -..,-E..,
5 .�
j
Number
Discharged
Correctly
Incorrectly Unknown
Sump Pumps
--
Foundation Drains
. ./
--
Roof Drains
; -
MI
eskl nUUai Sanitary Sewer Berke
Compliance Inspection
Rapt
Date 1 /
Name
PID Number
House Number
Alternate Mailing Address
White Copy: Property Owner
Time
Disk #
Owner /Occupant Signature
o am
O pm
Street Name
Yellow Copy: City of Eagan
Record Number
Time
Phone .
Inspector Signature
o am
o pm
Compliance
gi Oil" No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
o 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 e'
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Number of stacks Entered S.L at i _. * :.. °•1 per: <;
Length of Service:
Final Cleanout:
For Information call 651.470.2788
Pink Copy: Benjamin Franklin Plumbing
651 -222 -1551