774 Elrene Ct - Inspection Form4 City of Eagan
Residential Sanitary Sewer Service
Compliance Inspection
Date " f / a /
Name °'r r �.�.6
PID Number
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 N sump pump
Roots
Poorpe Jets
MineI D posits
Sag /Pip, Deflection
Dar/ ged Pipe
Transition
4" to 6" Transition:
I L�
1 _
White Copy: Property Owner
0 pm
Time /( _r'•
Disk #
Owner /Occupant Signature
O
House Number :-" Street Name
Alteniative Mailing Address f Phone
r /
''. /
' .
For information call 6,51.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks _Entered S,L,at
t k
27.-7. -~ _ 4,1.Y =..
.: ' .
7 f '
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
• p am
• o pm
4 , )
a 1 >
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
i � 6 1 � 9 .. ,1•• �� & �a'M1 -¢7 e
)
Fink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
Total
Sump pumps
1111
IIE
Foundation drains
MIN
IIII
Roof drains
111.
4 City of Eagan
Residential Sanitary Sewer Service
Compliance Inspection
Date " f / a /
Name °'r r �.�.6
PID Number
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 N sump pump
Roots
Poorpe Jets
MineI D posits
Sag /Pip, Deflection
Dar/ ged Pipe
Transition
4" to 6" Transition:
I L�
1 _
White Copy: Property Owner
0 pm
Time /( _r'•
Disk #
Owner /Occupant Signature
O
House Number :-" Street Name
Alteniative Mailing Address f Phone
r /
''. /
' .
For information call 6,51.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks _Entered S,L,at
t k
27.-7. -~ _ 4,1.Y =..
.: ' .
7 f '
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
• p am
• o pm
4 , )
a 1 >
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
i � 6 1 � 9 .. ,1•• �� & �a'M1 -¢7 e
)
Fink Copy: SEH
Account # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Ronald Goldser
774 Elrene Ct
Eagan MN 55123
Service Date 10/12/10
PO #
Camera inspection of sewer line.
Description Of Service
Camera inspection of sewer line
Terms: Due 11/11/2010
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Remit T o:
Benjamin Franklin Plumbing
1424 3r 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
lob # 216746
Quantity
DUNS #027314893
1
Please Detach and Return with Remittance
Invoice #
Date:
Page #
A66479
10/12/10
1 of 1
Unit Price Extended Price Tx
$215.00 $215.00
Balance Due $215.00
Please pay horn this Invoice Thank You
Amount Due
Amount Paid
Invoice # A66479
Date :
10/12/10
Account # 260536
City of Eagan /City Dept at:
$215..00
Residential an ta Sewer Service
Compliance nspection
it E
Date 1 () ) 0
PID Number
House Number , IL
Alternate Mailing Ad (e , "
s , P1141 4 ..71,Y
White Copy: ProperrtyOwner
Time
Name 170- g c
Owner /Occupant Signature
Disk #
o am
O pm
Street Name
Yellow Copy: City of Eagan
Record Number 2 - 1 t s�
Li Time
Phone
fie....••. � ���_..___
Inspector Signature
o am
O pm
Compliance
0
fl
}
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump Pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection ry 14-1
Damaged Pipe
Transition
4" to 6" Transition:
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
Number of stacks Entered S L. at
Length of Service:
No Access
O No one in
o Access to service lateral
needed
O Inspection refused
Final Cleanout:
For Information call 651.470.2788
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551
Total
Notes
r
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
Foundation Drains
i Roof Drains
Residential an ta Sewer Service
Compliance nspection
it E
Date 1 () ) 0
PID Number
House Number , IL
Alternate Mailing Ad (e , "
s , P1141 4 ..71,Y
White Copy: ProperrtyOwner
Time
Name 170- g c
Owner /Occupant Signature
Disk #
o am
O pm
Street Name
Yellow Copy: City of Eagan
Record Number 2 - 1 t s�
Li Time
Phone
fie....••. � ���_..___
Inspector Signature
o am
O pm
Compliance
0
fl
}
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump Pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection ry 14-1
Damaged Pipe
Transition
4" to 6" Transition:
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
Number of stacks Entered S L. at
Length of Service:
No Access
O No one in
o Access to service lateral
needed
O Inspection refused
Final Cleanout:
For Information call 651.470.2788
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551