801 Ivy Lane - Inspection Forms• City of Era an
Residential Sanitary Sewer Service
Compliance Inspection
• CF" O am
Date �� ! ! 1 Time • pm
Disk # Fri
Name 's
_r
PID Number
House Number - / Street Name r 1/ O
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Proper ty Owners
Owner /Occupant Signature
Non - Compliance
C11
O Clear water connections to Unable to push past
sanitary sewer feet
O Service lateral defects
O Defective rnanholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number i
Time
•
•
Phone - . -.u
Inspector Signature
Obstruction
Final Cleanout:
No one in
"O Acr'egs o ser civ e
lateral needed
o am
0 pm
0 Inspection
refused
Entered S.L..at
Pink Copy: SEH
Notes
Number Discharged
Total
Correctly Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
• City of Era an
Residential Sanitary Sewer Service
Compliance Inspection
• CF" O am
Date �� ! ! 1 Time • pm
Disk # Fri
Name 's
_r
PID Number
House Number - / Street Name r 1/ O
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Proper ty Owners
Owner /Occupant Signature
Non - Compliance
C11
O Clear water connections to Unable to push past
sanitary sewer feet
O Service lateral defects
O Defective rnanholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number i
Time
•
•
Phone - . -.u
Inspector Signature
Obstruction
Final Cleanout:
No one in
"O Acr'egs o ser civ e
lateral needed
o am
0 pm
0 Inspection
refused
Entered S.L..at
Pink Copy: SEH
410
City oi Lapo
Residential Sanitary Sewer Service
Compliance Inspection
//)
Date/ k .„/
)
Name
PID Number
Disk#011—L1J—LL
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
4" to 6" Transition:
White Copy: Property Owner
Time arn
• 9 P
House Number Street Name
Alternative Mailing Addpe
'Owner/Occupant Signature
Non
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
Record Number
Set vice Lateral Inspection Findings Number of stacks Entered S L at
Notes
0 am
•
Time • prn
L,.//
Phone /-„-- --/
— • •
Inspector Signature
For information call 2788
Obstruction
Unable to push past
feet
• ,,
Roots /
/ , 1
.,-.:,----" ..-- - ../ 1 . . i .,•
Po •Pipoints ,/ ,,,, : E.. -.....,..
7 ir _ ,. :. ., .••• ; . )
, / ....-.(- / I
Mine (Deposits -1.=- ;.- i).- i ..---"'' :_ _.`,.'..- . .:,.---'
SaglPipt Deflection 4.1',:2/..1?.-4 .1, - );')/-: Zli - re -1 ' L' //
/ 1
e." --,
Damaged‘Pipe --+ --7/ //),-"- c: //-1- ,.2.-- --, 7;'
Transition ) i /) -, - - /-' , .- - f: -
..,._.- . i (-) ,
,/./.; it , / ()-----7r 7)
, - .., - ,-- (S ,-;—,_ /),-2/)).:-g
,/)
<7?
i i ,,-. ,,, ,,,,, fit I
Length of Service: Final Cleanout:
No Access
q No one in
latera n eded
Access to service
efl
0 Ins
refused
Yellow Copy: City of Eagan Pink Copy: SEH
Number
Correctly
Discharged.
Incorrectly Unknown
Total
Sump pumps
Foundation drains
Roof drains
410
City oi Lapo
Residential Sanitary Sewer Service
Compliance Inspection
//)
Date/ k .„/
)
Name
PID Number
Disk#011—L1J—LL
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
4" to 6" Transition:
White Copy: Property Owner
Time arn
• 9 P
House Number Street Name
Alternative Mailing Addpe
'Owner/Occupant Signature
Non
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
Record Number
Set vice Lateral Inspection Findings Number of stacks Entered S L at
Notes
0 am
•
Time • prn
L,.//
Phone /-„-- --/
— • •
Inspector Signature
For information call 2788
Obstruction
Unable to push past
feet
• ,,
Roots /
/ , 1
.,-.:,----" ..-- - ../ 1 . . i .,•
Po •Pipoints ,/ ,,,, : E.. -.....,..
7 ir _ ,. :. ., .••• ; . )
, / ....-.(- / I
Mine (Deposits -1.=- ;.- i).- i ..---"'' :_ _.`,.'..- . .:,.---'
SaglPipt Deflection 4.1',:2/..1?.-4 .1, - );')/-: Zli - re -1 ' L' //
/ 1
e." --,
Damaged‘Pipe --+ --7/ //),-"- c: //-1- ,.2.-- --, 7;'
Transition ) i /) -, - - /-' , .- - f: -
..,._.- . i (-) ,
,/./.; it , / ()-----7r 7)
, - .., - ,-- (S ,-;—,_ /),-2/)).:-g
,/)
<7?
i i ,,-. ,,, ,,,,, fit I
Length of Service: Final Cleanout:
No Access
q No one in
latera n eded
Access to service
efl
0 Ins
refused
Yellow Copy: City of Eagan Pink Copy: SEH
of
esi ential Sanitary Sewer Service
Compliance Inspection
Date f 1 ;i / L)
Name
PID Number
House Number
� s
Alternate MailingAAddress Phone
For Information call 651.470.2788
ompliance
No foundation drain connection
No roof drain connection
o Sump pit not connected to
sanitary sewer
o j,._Sump Pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
Disk #
Owner /Occ6pant 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
O am
O pm
Street Name
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
Time
Inspector Signature
Entered S.L. at
ft-1 0
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout: 3 .„
o am
O pm
Number Discharged
Surnp Pumps
Foundation Drains
Roof Drains
Total
Y t
Correctly incorrectly Unknown
Notes
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Account # 260536
Service Date 09/28/10
PO #
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service
Camera inspection of sewer line
Remit Io:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 -604 -4285 FAX: 612 -822 -5408
FID#27-1025956
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
George Toby
801 Ivy Ln
Eagan MN 55123
Job # 217376
Quantity
1
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Invoice #
Date:
Page #
A67225
09/28/10
1 of 1
Unit Price Extended Price Tx
DUNS #027314893
Terms: Due 10/28/2010 Please pay from this Invoice.. Thank You
Amount Due
Amount Paid
$215.00 $215.00
Balance Due $215.00
Invoice # A67225
Date :
09/28/10
Account # 260536
City of Eagan /City Dept at:
$215.,00