3440 Ivy Ct - Inspection FormAccount# 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Kathy Paden
3440 Ivy Ct
Eagan MN 55123
Service Date 09/10/10
PO #
Camera inspection of sewer line, Pull & reset toilet.
Description Of Service
Camera inspection of sewer line
DUNS #02'7314893
Ter ms: Due 10/10/2010 Please pay from this Invoice Ihank You
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signatur e
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
Job # 216535
Quantity
1
Please Detach and Return with Remittance
Unit Price Extended Price Tx
Amount Due
Amount Paid
$215.00 $215.00
Balance Due $215.D0
Invoice # A71511
Date :
Invoice #
Date:
Page #
A71511
09/10/10
1 of 1
09/10/10
Account# 260536
City of Eagan /City Dept at:
$215.00
Residential Sanitary Sewer Service
Compliance Inspection .
\ ,{
Date r _1 /O !.
Name
House Number
•
White Copy: Property Owner
Time
Owner /Occupant Signature
Disk #
PID Number
o am
O pm
Street Name
Yellow Copy: City of Eagan
Record Number
O :am
Time 0 pm
Alternate Mailing Address ,Phone.
Inspector Signature
Compliance
No:foundation drain connection
Nf 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
PoorPipe .Joints "..
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Number of stacks Entered S .. at
Length of Service:
Final Cleanout_, -/
For Information call 651.478.2788
Total
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
Correctly Incorrectly Unknown
Dotes
Pink Copy.: Benjamin Franklin Plumbing
651- 222 -1 551
Cit of Ca a
y � s
Residential Sanitary Sewer Service
Compliance Inspection
Date / ›. 1 f {
°
Name :5
RID Number
I-louse Number
Alter native Mailing Address
i1
's1
Poor Pipe joints
Mineral Deposits
4" to 6" Transition:
OwnerlOccupant 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
O No sump pump
Service Lat cal Inspection Findings
I ..s.'.:.:..
Roots
White Copy: Property Owner
•�
Time •
Disk #
.;Street Name
am
Pm
Non - Compliance
O Clear water connections
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Record Number
Length of Service:
Yellow Copy: City of Eagan
Time
=Phone ,)
Obstruction
Unable to push past
feet
Numb ,r of stacks ...Entered S at
Transition k
o am
•
• O pm
"2 -2
Inspector Signature
For information call 651.470.2788
Final Cleanout:
No Access
No one in
!1
0 Aces C61sivic e
lateral needed
0 Inspection
refused
i i i
Sag/Pipe Deflection -7 7,.s 7 . '7/3/2/ ?4,, �� y l e..-..)
Damaged Pipe 64 Y; . • --.7.: t ,1 ; / ; -. ': )
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
Total
Sump pumps
Foundation drains
IIIII
---
Roof drains
Cit of Ca a
y � s
Residential Sanitary Sewer Service
Compliance Inspection
Date / ›. 1 f {
°
Name :5
RID Number
I-louse Number
Alter native Mailing Address
i1
's1
Poor Pipe joints
Mineral Deposits
4" to 6" Transition:
OwnerlOccupant 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
O No sump pump
Service Lat cal Inspection Findings
I ..s.'.:.:..
Roots
White Copy: Property Owner
•�
Time •
Disk #
.;Street Name
am
Pm
Non - Compliance
O Clear water connections
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Record Number
Length of Service:
Yellow Copy: City of Eagan
Time
=Phone ,)
Obstruction
Unable to push past
feet
Numb ,r of stacks ...Entered S at
Transition k
o am
•
• O pm
"2 -2
Inspector Signature
For information call 651.470.2788
Final Cleanout:
No Access
No one in
!1
0 Aces C61sivic e
lateral needed
0 Inspection
refused
i i i
Sag/Pipe Deflection -7 7,.s 7 . '7/3/2/ ?4,, �� y l e..-..)
Damaged Pipe 64 Y; . • --.7.: t ,1 ; / ; -. ': )
Pink Copy: SEH