3781 Windtree Dr - Inspection FormAccount # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt,
Eagan MN 55122
Service At:
David Brunet
3781 Windtree Dr.
Eagan MN 55123
Service Date 09/13/10
PO #
Camera inspection of sewer line. Pull & reset toilet.
Description Of Service
Camera inspection of sewer line.
Terms: Due 10/13/2010
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 # 216446
Quantity
DUNS #027314893
1
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Amount Due
Amount Paid
Invoice #
Date:
Page #
A71509
09/13/10
1 of 1
Unit Price Extended Price Tx
$215.00 $215.00
Balance Due $215,00
Please pay from this Invoice., Ihank You
Invoice #
Date :
A71509
09/13/10
Account # 260536
City of Eagan /City Dept at:
$215.
Residential Semler Sewer Service
Compliance inspection
or Ea
Date 1
Name
PID Number
House Number 3) I
i .. -
Alte ate Mailing Phone
N ` 1 ( c 3 0
° � v Ow /O ccupant Signature
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
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: Property Owner
Time
P Disk #
7
t r?
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
P.Q.c._ Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
J
Inspector Signature
For Information call 651.470.2788
Unable to push past
feet
Entered S at / 0 _'
Time
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout: C-\
o am
o pm
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
IIIII
Foundation Drains
.
Roof Drains
IIIII_
Residential Semler Sewer Service
Compliance inspection
or Ea
Date 1
Name
PID Number
House Number 3) I
i .. -
Alte ate Mailing Phone
N ` 1 ( c 3 0
° � v Ow /O ccupant Signature
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
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: Property Owner
Time
P Disk #
7
t r?
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
P.Q.c._ Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
J
Inspector Signature
For Information call 651.470.2788
Unable to push past
feet
Entered S at / 0 _'
Time
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout: C-\
o am
o pm
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551
Q" City album
Residential Sanitary Sewer Service
Compliance Inspection
Date 9/ & 7 / /o
Name ./ d 3
PID Number
House Number
Time
f r`. - Disk #
• ,�. 9
•wpm
w
/
Street Name 77e 'iF
Alterriative M,ailingAddress
OwnerlOccupant Signature
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
Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Service Lateral Inspection Findings
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
•
Time • 0 a O pm
Phone
Obstruction
Unable to push past
feet
v
f ' /inspector Signature
Final Cleanout:
No Access
O No one in
d
Access to service
lateral needed
O Inspection
refused
Entered S.
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
f
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
' ° ,�; _ !' ,
} r f � 9 q,y
V y , R
,: �: '
C:
(71 �` l /Ira y_..
t' V rf,? r ! :l _ ,�
Total
Sump pumps
p P P
4.
®
Foundation drains
Roof drains
---
f` ` l k `'•-•ry ‘,.-4./ j t i
Q" City album
Residential Sanitary Sewer Service
Compliance Inspection
Date 9/ & 7 / /o
Name ./ d 3
PID Number
House Number
Time
f r`. - Disk #
• ,�. 9
•wpm
w
/
Street Name 77e 'iF
Alterriative M,ailingAddress
OwnerlOccupant Signature
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
Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Service Lateral Inspection Findings
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
•
Time • 0 a O pm
Phone
Obstruction
Unable to push past
feet
v
f ' /inspector Signature
Final Cleanout:
No Access
O No one in
d
Access to service
lateral needed
O Inspection
refused
Entered S.
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
f
Pink Copy: SEH