3470 Trails End Rd - Inspection FormAccount # 260536
Service Date 09/17/10
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
Minneapoils 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:
Judy & Gordan Pryor
3470 Trails End Rd
Eagan MN 55123
Job # 216713
Quantity
1
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [
Acct # Exp Date
Name on Card
Signatur e
Invoice #
Date:
Page #
A72285
09/17/10
1 of 1
Unit Price Extended Price Tx
$215.00 $215.00
Balance Due $215.,00
DUNS #027314893
Terms: Due 10/17/2010 Please pay from this Invoice. Thank You
Amount Due
Amount Paid
Invoice # A72285
Date :
09/17/10
Account 260536
City of Eagan/City Dept at:
$215,00
o bon
Residentia Sanitary Sewer Berke
Comp ce inspection
Date '!
Name
PID Number
House Number
Alternate Mailing Address
Compliance
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Time
Owner /Occupant Signature
For Information call 651.470.2788
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
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
o am
o pm
Street Name
} Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Phone
Unable to push past
#., feet
Time
Inspector Signature
Number of stacks ? Entered S L at
o am
o pm
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Notes
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump Pumps
l
Foundation Drains
';.
Roof Drains
•
3
� .
o bon
Residentia Sanitary Sewer Berke
Comp ce inspection
Date '!
Name
PID Number
House Number
Alternate Mailing Address
Compliance
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Time
Owner /Occupant Signature
For Information call 651.470.2788
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
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
o am
o pm
Street Name
} Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Phone
Unable to push past
#., feet
Time
Inspector Signature
Number of stacks ? Entered S L at
o am
o pm
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
4 161
City f Ea a
Y i o
Residential Sanitary Sewer Service
Compliance Inspection
Date t°
Name a
House Number 7
Alternative Mailing Address
Transition
Poor Pipeiciints
Mineral Deposits
Sag /P,i6e Deflection
Damaged Pipe
4" to 6" Transition:
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
White Copy: Property Owner
r- �•..'t' am
Time : -• pm
Disk #
PID Number
��. Street Name di. /1
'Owner /Occupant Signature
For information call 651.470.2788
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
Service Lateral inspection Findings Number of stacks
Roots
• 7
1 -;� �i,: f j a t , �:)£.. L. --i" _ f.+'' .....":. / -9 ",?- 1,- te .
` , 1 ... ,, ' ' 1 ` ,F° ✓/ `; - .... ' , '4 ? (' ,. , i '' 1
Length of Service:
Yellow Copy: City of Eagan
Record Number '1
Time
Phone -`r , ..)
Inspector Signature
Obstruction
Unable to push past
feet.
Entered S.L.at
s
•
•
Final Cleanout:
o am
O pm
No Access
O No one in
Access to service
lateral needed
O Inspection'
refused
Pink Copy: SEFJ
Number
Correctly
Discharged
Incorrectly Unknown
Notes
Total
Sump pumps
--EI
Foundation drains
ME
Roof drains
4 161
City f Ea a
Y i o
Residential Sanitary Sewer Service
Compliance Inspection
Date t°
Name a
House Number 7
Alternative Mailing Address
Transition
Poor Pipeiciints
Mineral Deposits
Sag /P,i6e Deflection
Damaged Pipe
4" to 6" Transition:
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
White Copy: Property Owner
r- �•..'t' am
Time : -• pm
Disk #
PID Number
��. Street Name di. /1
'Owner /Occupant Signature
For information call 651.470.2788
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
Service Lateral inspection Findings Number of stacks
Roots
• 7
1 -;� �i,: f j a t , �:)£.. L. --i" _ f.+'' .....":. / -9 ",?- 1,- te .
` , 1 ... ,, ' ' 1 ` ,F° ✓/ `; - .... ' , '4 ? (' ,. , i '' 1
Length of Service:
Yellow Copy: City of Eagan
Record Number '1
Time
Phone -`r , ..)
Inspector Signature
Obstruction
Unable to push past
feet.
Entered S.L.at
s
•
•
Final Cleanout:
o am
O pm
No Access
O No one in
Access to service
lateral needed
O Inspection'
refused
Pink Copy: SEFJ