813 Trails End Rd - Inspection Form40 Cif of
ra
Y
Residential Sanitary Sewer Service
Compliance Inspection
Date' '/
Time • o om
(" Disk #
PID Number
R
[Name
House Number
Alternative Mailing Address Phone
/'
Street Name
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
O Sump pump properly piped
O 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
Service Lateral Inspection Findings Number of stacks
Roots r
PoOr• Pipe Joints "" i'.'7„--
I 7
/ r 3 � t ,/,-7/,
Mine� !•' D eposits r x , �
Sag /Pi Deflection --' ;%' %
1 \
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
,
Length of Service:
WINNE
Yellow Copy: City of Eagan
Record Number 7
Time
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
• 0 a
• O pm
No Access
O No one in
Access to service
1 lateral needecl,..,
O I nspecttdn
refused
Entered S . at
r^a
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
Total
Sump pumps
Foundation drains
Roof drains
40 Cif of
ra
Y
Residential Sanitary Sewer Service
Compliance Inspection
Date' '/
Time • o om
(" Disk #
PID Number
R
[Name
House Number
Alternative Mailing Address Phone
/'
Street Name
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
O Sump pump properly piped
O 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
Service Lateral Inspection Findings Number of stacks
Roots r
PoOr• Pipe Joints "" i'.'7„--
I 7
/ r 3 � t ,/,-7/,
Mine� !•' D eposits r x , �
Sag /Pi Deflection --' ;%' %
1 \
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
,
Length of Service:
WINNE
Yellow Copy: City of Eagan
Record Number 7
Time
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
• 0 a
• O pm
No Access
O No one in
Access to service
1 lateral needecl,..,
O I nspecttdn
refused
Entered S . at
r^a
Pink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service Date 10 /01/10 PO # lob # 216845
Camera inspection of sewer line.
Description Of Service Quantity Unit Price Extended Price Tx
Camera inspection of sewer line. 1 $215.00 $215.00
DUNS #027314893
Terms: Due 10/31/2010 Please pay from this Invoice.. Thank You
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
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
F1D #27- 1025956
Service At:
Janice Sowieja
813 T rails End Rd
Eagan MN 55123
Amount Due
Amount Paid
Balance Due $215,00
Invoice # A67243
Date :
Invoice # A67243
Date: 10/01/10
Page # 1 of 1
10 /01 /10
Account 260536
City of Eagan /City Dept at:
$215,00
n
Residential Sanitarst Sanity . Sewer Service
Compliance Inspection
Date
Name
Number
House Number
Alternate Mailing Address
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump Pump properly piped
0 No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
IC)
4" to 6" Transition:
White Copy: Property Owner
Time
.mot k
Disk #
Owner /Occupant Signature
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Time
Phone
)
For Information call 651.470.2788
Unable to push past
feet
Inspector Signature
Entered S. at
o am
o pm
No Access
o No one in
o Access to service lateral
needed
o inspection refused
•
r2
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551
Total
Notes
4.1_
'%
A r 9
Ao q't`
tlgz-1c: fte, .'
`7' 5 X
r
8'C. >
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
Foundation Drains
t
Roof Drains
('
n
Residential Sanitarst Sanity . Sewer Service
Compliance Inspection
Date
Name
Number
House Number
Alternate Mailing Address
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump Pump properly piped
0 No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
IC)
4" to 6" Transition:
White Copy: Property Owner
Time
.mot k
Disk #
Owner /Occupant Signature
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Time
Phone
)
For Information call 651.470.2788
Unable to push past
feet
Inspector Signature
Entered S. at
o am
o pm
No Access
o No one in
o Access to service lateral
needed
o inspection refused
•
r2
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551