4157 Rahn Rd - Inspection FormAccount # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Karen Coggins
4157 Rahn Rd
Eagan MN 55122
Service Date 08/11/10
PO #
Camera inspection of sewer line.
Description Of Service
Camera inspection of sewer line
Remit Io:
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
Job it 214893
Quantity
1
Please Detach and Return with Remittance
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] AmExp [ ] Discover [ ]
Acct # Exp Date
Name on Card
Signature
Invoice #
Date:
Page #
A65395
08/11/10
1 of' 1
Unit Price Extended Price Tx
Amount Due
Amount Paid
$215.00 $215.00
Balance Due $215..00
DUNS #02731489.3
I erms: Due 9/10/2010 Please pay from this Invoice, Thank You
Invoice #
Date :
A65395
08/11/10
Account # 260536
City of Eagan/City Dept at:
$215..00
es cIe tia! Sanitary Sewer Service
, city �d
o p c inspect s
Date
Name
PID Number
House Number
• f Owner /Occupant Signature
Compliance
t<<_ /Th
Time
b Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
V No sump pump
No foundation drain connection
No roof drain connection
}I� °7
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Property Owner
Disk tt
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
Obstruction
Length of Service: q1'9
Yellow Copy: City of Eagan
Record Number �' 1 3
Time
Alternate Mailing Address Phone
Unable to push past
feet
inspector Signature
Entered S.L. at — ¶ ! 3
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection 7 tj ;--)
Damaged Pipe
Transition
o am
o pm
For Information call 651.470.2788
No Access
o No one in
O Access to service lateral
needed
O Inspection refused
Final Cleanout:
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
Total
Correctly Incorrectly Unknown
Notes
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551
