3474 Trails End Rd - Inspection FormAccount # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt.
Eagan MN 55122
Service Date 09/22/10 PO #
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service
Camera inspection of sewer line
Remit To:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapoils MN 55411
Invoice
Benjamin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612 -604 -4285 FAX: 612 -822 -5408
FID#27-1025956
Job # 217148
1
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AnrExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Quantity
Please Detach and Return with Remittance
Service At:
Nancy Namur
3474 Trails End Rd
Eagan MN 55123
Unit Price Extended Price Tx
DUNS #027314893
Terms: Due 10/22/2010 Please pay from this Invoice., Thank You
Amount Due
Amount Paid
Date :
Invoice #
Date:
Page #
Invoice #
A72298
09/22/10
1 of 1
$215.00 $215.00
Balance Due $215.00
A72298
09/22/10
Account# 260536
City of Eagan /City Dept at:
$215.00
- Res dent al Sanitary Sewer Services
- icompliance Inspection -
try :nen
Date 9 ic i 1 t'
Name 11 .,c, (1 4 .,
RD Number
House Number
/
sump pump
Transition
3 LI 1 Lk
Alternate Mailing Address
Owner/Occupant Signature
Compliance
No foundation drain connection
No roof drain connection
o Sump pit not connected to
sanitary sewer
o Sump Pump properly piped
Time
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection t c ) \ 5
Damaged Pipe
4" to 6" Transition:8O
White Copy: Property Owner
) (5- am
• l5 - 0 pm
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
Street Name
Yellow Copy: City of Eagan
Record Number 0 1
Obstruction
Time
Phone
For Information call 651.470.2788
Unable to push past
feet
Number of stacks Entered S L
Inspector Signature
No Access
o No one in
O Access to service lateral
needed
O Inspection refused
O am
o pm
Length of Service: '" Final Cleanout:c20 23 1 < '
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Total
N otes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
Foundation Drains
r
Roof Drains
0
- Res dent al Sanitary Sewer Services
- icompliance Inspection -
try :nen
Date 9 ic i 1 t'
Name 11 .,c, (1 4 .,
RD Number
House Number
/
sump pump
Transition
3 LI 1 Lk
Alternate Mailing Address
Owner/Occupant Signature
Compliance
No foundation drain connection
No roof drain connection
o Sump pit not connected to
sanitary sewer
o Sump Pump properly piped
Time
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection t c ) \ 5
Damaged Pipe
4" to 6" Transition:8O
White Copy: Property Owner
) (5- am
• l5 - 0 pm
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
Street Name
Yellow Copy: City of Eagan
Record Number 0 1
Obstruction
Time
Phone
For Information call 651.470.2788
Unable to push past
feet
Number of stacks Entered S L
Inspector Signature
No Access
o No one in
O Access to service lateral
needed
O Inspection refused
O am
o pm
Length of Service: '" Final Cleanout:c20 23 1 < '
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Name ,P0
City ill fhp,an
Residential Sanitary Sewer Service
Compliance inspection
Datet--- 4 I
I Time '; pm
• am
Alternative Nailing Address
Disk #
RD Number , 4
Pk
3
House Number
714 Street Name
t
1"" 1 ,i A a
OwnerlOccupant Signature
For information call 651.470.2788
Compliance
0 No foundation drain connection
0 No roof drain connection
0 Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
Roots
\b
Poor Pipel ints '
Mir eposits / -
Non
0 Clear water connections to
sanitary sewer
0 Service lateral defects
0 Defective manholes
0 Sump pump connected to sanitary
sewer
o Flexible sump pump piping
Number of stacks
7
d'1
Sag/P1 ie Deflection ri) 4-0
Da Pipe
Transition
4" to 6" Transition:
White Copy: Property Ownei
)
Length of Service:
Yellow Copy: City of Eagan
Record Number
A/
er
7V
r7
Phone
Obstruction
Unable to push past
feet
Entered S L at
/
)
Time
• 0 am
• 0 pm
Inspector Signature
„
No Access
0 No one in
0 Access to service
lateral needed
0 Inspection
refused
a
Final Cleanout:
Pink Copy: SE H
Number
Correctly
Discharged
Incorrectly Unknown
Notes
Total
Sump pumps
ill
Foundation drains
MIN
Roof drains
Name ,P0
City ill fhp,an
Residential Sanitary Sewer Service
Compliance inspection
Datet--- 4 I
I Time '; pm
• am
Alternative Nailing Address
Disk #
RD Number , 4
Pk
3
House Number
714 Street Name
t
1"" 1 ,i A a
OwnerlOccupant Signature
For information call 651.470.2788
Compliance
0 No foundation drain connection
0 No roof drain connection
0 Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
Roots
\b
Poor Pipel ints '
Mir eposits / -
Non
0 Clear water connections to
sanitary sewer
0 Service lateral defects
0 Defective manholes
0 Sump pump connected to sanitary
sewer
o Flexible sump pump piping
Number of stacks
7
d'1
Sag/P1 ie Deflection ri) 4-0
Da Pipe
Transition
4" to 6" Transition:
White Copy: Property Ownei
)
Length of Service:
Yellow Copy: City of Eagan
Record Number
A/
er
7V
r7
Phone
Obstruction
Unable to push past
feet
Entered S L at
/
)
Time
• 0 am
• 0 pm
Inspector Signature
„
No Access
0 No one in
0 Access to service
lateral needed
0 Inspection
refused
a
Final Cleanout:
Pink Copy: SE H