3448 Ivy Ct - Inspection FormCity of 1a an
Residential Sanitary Sewer Service
Compliance Inspection
D a t e / / ja Time
Name
PID Number
House Number 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 Na sump pump
Service Lateral Inspection Findings
Roots
Poor•PipeJoints
Mineral Deposits
Sag /Pipe Deflection -
y .
Damaged Pipe
'Transition
4" to 6 "Transition:
l i
OwnerlOccupant Signature
F
White Copy: Property Owner
Disk #
, p m
•
p pm
r
1
Number of stacks
Length of Service:
MOM
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
) --.''' ,r -----/ : '''''' ,L(2,1
720) „,.'<912-14.0 /r'-,�` ( ( 4 ,'
- ;: = -a - '7 i -' ) :
`:
/
Yellow Copy: City of Eagan
Record Number
Time
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
o am
•
• Opm
Phon ��-
No Access
O No one in
Access to service
l ate���ee�d ..¢�
O Inspe`ttion
refused
Entered S L at
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
City of 1a an
Residential Sanitary Sewer Service
Compliance Inspection
D a t e / / ja Time
Name
PID Number
House Number 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 Na sump pump
Service Lateral Inspection Findings
Roots
Poor•PipeJoints
Mineral Deposits
Sag /Pipe Deflection -
y .
Damaged Pipe
'Transition
4" to 6 "Transition:
l i
OwnerlOccupant Signature
F
White Copy: Property Owner
Disk #
, p m
•
p pm
r
1
Number of stacks
Length of Service:
MOM
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
) --.''' ,r -----/ : '''''' ,L(2,1
720) „,.'<912-14.0 /r'-,�` ( ( 4 ,'
- ;: = -a - '7 i -' ) :
`:
/
Yellow Copy: City of Eagan
Record Number
Time
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
o am
•
• Opm
Phon ��-
No Access
O No one in
Access to service
l ate���ee�d ..¢�
O Inspe`ttion
refused
Entered S L at
Pink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwarz
3419 Coachman Pt
Eagan MN 55122
Service At:
Bea Healy
3448 Ivy Ct
Eagan MN 55123
Service Date 08/24/10
Description Of Service
PO #
Camera inspection of sewer line. Pull & reset toilet.
Camera inspection of sewer line.
Remit To:
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
Job # 215432
Quantity
1
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Amount Due
Amount Paid
Invoice #
Date:
Page #
A65376
08/24/10
1 of 1
Unit Price Extended Price Tx
$215.00 $215.00
Balance Due $215.00
DUNS #027314893
Terms: Due 9/23/2010 Please pay from this Invoice. Thank You
Please Detach and Return with Remittance
Invoice #
Date :
A65376
08/24/10
Account # 260536
City of Eagan /City Dept at:
$215,00
Residential Sanitary Sewer Service
+ 11, -
Compliance Inispect tyfEaa
Date ,,a
Name
PID Number
House Number
Alternate Mailing Address
Time
Owner /Occupant Signature
For Information call 651.470.2788
Compliance
No foundation drain connection
O'. No roof drain connection
o Sump pit not connected to
sanitary sewer
O Sump Pump properly piped
▪ No sump pump
Service Lateral inspection Findings
Roots
Poor Pipe Joints ()
Mineral Deposits
i
Sag /Pipe 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
Number of stacks
Street Name
o am
o pm
(� . , '
0 .� c Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Time
Phone
Unable to push past
feet
Inspector Signature
No Access
o No one in
o Access to service lateral
needed
O Inspection refused
v Entered S.L. at
Final Cleanout:
o am
o pm
Pink Copy: Benjamin Franklin Plumbing
651 -222 -1551
Total
N otes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
f
Foundation Drains
'
■
Roof Drains
Residential Sanitary Sewer Service
+ 11, -
Compliance Inispect tyfEaa
Date ,,a
Name
PID Number
House Number
Alternate Mailing Address
Time
Owner /Occupant Signature
For Information call 651.470.2788
Compliance
No foundation drain connection
O'. No roof drain connection
o Sump pit not connected to
sanitary sewer
O Sump Pump properly piped
▪ No sump pump
Service Lateral inspection Findings
Roots
Poor Pipe Joints ()
Mineral Deposits
i
Sag /Pipe 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
Number of stacks
Street Name
o am
o pm
(� . , '
0 .� c Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Time
Phone
Unable to push past
feet
Inspector Signature
No Access
o No one in
o Access to service lateral
needed
O Inspection refused
v Entered S.L. at
Final Cleanout:
o am
o pm
Pink Copy: Benjamin Franklin Plumbing
651 -222 -1551