3456 Ivy Ct - Inspection FormCity of Ea
pa
p
Residential Sanitary Sewer Service
Compliance Inspection
) a
Date(/ f Time �C J• o pm
Name
Disk # C1l -4 1 1
HD Number
House Number - ( i') Street Name
Alternative Mailing Address
For information call 651.470.2788
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 Number ofstacks Enter ed,S L. at •
Roots ! - �� J , i, -4-- -_� . ,' • a� 2/ r �
Poor Pipe Joints t" I - -°-'.� �:, ?c,i'�� - '- / �:? -)�� -7 %... �- il �� ' fr' r P c A
Mineral Deposits. -1 e- - I • c - a 1 -- — % r /
Sag /Pipe Deflection 1- „- ? " -;/' `; �i I i fir° - 7 , '.,'7r/� -. / f it), ' .af%' 1 , , A/ '
Damaged Pipe 1)
_ c. ��- ' <' -'' °� ' / _� - % J 1. ....-
.-_-- /
-, ,
Transition -= :7:7 "i ,, �-) }.'_ 7'. - �/
_� �� - -
4” to 6 "Transition:
White Copy: Property Owner
Owner /Occupant Signature
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:
Yellow Copy: City of Eagan
Record Number
Time
1
Phone .� Tr,
inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
0 a
•
• o Pm
No Access
O No one in
Access to service
lateral nee ,-.
7/
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
Total
Sump pumps
Foundation drains
a
Roof drains
®
City of Ea
pa
p
Residential Sanitary Sewer Service
Compliance Inspection
) a
Date(/ f Time �C J• o pm
Name
Disk # C1l -4 1 1
HD Number
House Number - ( i') Street Name
Alternative Mailing Address
For information call 651.470.2788
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 Number ofstacks Enter ed,S L. at •
Roots ! - �� J , i, -4-- -_� . ,' • a� 2/ r �
Poor Pipe Joints t" I - -°-'.� �:, ?c,i'�� - '- / �:? -)�� -7 %... �- il �� ' fr' r P c A
Mineral Deposits. -1 e- - I • c - a 1 -- — % r /
Sag /Pipe Deflection 1- „- ? " -;/' `; �i I i fir° - 7 , '.,'7r/� -. / f it), ' .af%' 1 , , A/ '
Damaged Pipe 1)
_ c. ��- ' <' -'' °� ' / _� - % J 1. ....-
.-_-- /
-, ,
Transition -= :7:7 "i ,, �-) }.'_ 7'. - �/
_� �� - -
4” to 6 "Transition:
White Copy: Property Owner
Owner /Occupant Signature
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:
Yellow Copy: City of Eagan
Record Number
Time
1
Phone .� Tr,
inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
0 a
•
• o Pm
No Access
O No one in
Access to service
lateral nee ,-.
7/
O Inspection
refused
Pink Copy: SEH
Account# 260536
City of Eagan/City Dept at:
Wayne Schwarz
3419 Coachman Pt.
Eagan MN 55122
Camera inspection of sewer line, Pull & reset toilet.
Remit Io:
Benjamin Franklin Plumbing
14243rd St N
Minneapolis MN 55411
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 -604 -4285 FAX: 612-822-5408
F1D #27- 1025956
Service Date 08/31/10 PO # Job # 216059
Please Detach and Return with Remittance
Service At:
Scott Fr aizier
3456 Ivy Ct
Eagan MN 55123
Description Of Service Quantity Unit Price Extended Price Tx
Camera inspection of sewer line 1 $215.00 $215.00
DUNS #02731489.3
Terms: Due 9/30/2010 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 # A65760
Date: 08/31/10
Page # 1 of 1
Balance Due $215,00
Invoice #
Date :
A65760
08/31/10
Account# 260536
City of Eagan/City Dept at:
$215.00
afEatan
Residential Sanitary Sewer Service
Compliance Inspection
Date ` 1, 1
Name -
White Copy: Property Owner
Time
Owner /Occupant Signature
Disk #
: ra':
o am
o pm
Street Name
Yellow Copy: City of Eagan
Record Number
I
PID Number
House Number
Alternate Mailing Address
Time
Phone
Inspector Signature
O am
o pm
,22w - 7 /,1'
Compliance
b No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump Pump properly piped
tS 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
/i feet
r'r
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Service Lateral Inspection Fin
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
dings
7, /
Number of stacks Entered S..L at r
Length of Service:
Final Cleanout:
For Information call 651.470.2788
Total
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
Ell
z :
Correctly Incorrectly Unknown
Notes
//2 C‘."
1 h /1 V
/I 1;i 7 1
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551