4862 Windsor Ct - Inspection FormAccount # 260536
City of Eagan/City Dept at:
Wayne Schwarz
3419 Coachman Pt,
Eagan MN 55122
Service At:
Mark & Virginia Sisson
4862 Windsor Ct
Eagan MN 55122
Service Date 08 /11 /10
Description Of Service
PO #
Camera inspection of sewer line.
Camera inspection of sewer line
Remit To:
Benjamin Franklin Plumbing
1424 3rd St N
Minneapoils MN 55411
Invoice
Benj amin Franklin Plumbing
1424 3rd St N
Minneapolis MN 55411
612- 604 -4285 FAX: 612-822-5408
FID #27- 1025956
Job # 212582
Quantity
1
Please Detach and Return with Remittance
Check Enclosed [ ]
Master Card [ ] Visa [ ] AmExp [ ]
Acct #
Name on Card
Signature
Method of Payment
Discover [ ]
Exp Date
Unit Price
$215.00
Amount Due
Amount Paid
Balance Due
Date :
Invoice #
Date:
Page #
A65398
08/11/10
1 of 1
Extended Price Tx
$215.00
$215.00
DUNS #027314893
Terms: Due 9/10/2010 Please pay from this Invoice. I hank You
Invoice # A65398
08/11/10
Account 260536
City of Eagan /City Dept at:
$215,.00
Residential Sanitary Sewer Service
a
Compliance Inspection
Date / / f U
Name j�f� �.S�G
PID Number
House Number
Alternate Mailing Address
1.74 t
For Information call 651.470.2788
r ompliance
o N foundation oun d
ation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection //
Damaged Pipe ( 3
Transition
White Copy: Property Owner
Time
Owner /Occupant Signature
Non - Compliance
o Clear water connections to
sanitary sewer
o Service lateral defects
o Defective manholes
o Sump pump connected to
sanitary sewer
o Flexible sump pump piping
'$ 3D ,
4" to 6" Transition: [ g
Disk #
a am
o pm
Street Name
Number of stacks
Yellow Copy: City of Eagan
Record Number
Time
Phone
Inspector Signature
Obstruction
Unable to push past
feet
Length of Service: 1 (.�
Entered S.L. at
2 s
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
Total
Notes
Number
Discharged
Correctly
Incorrectly Unknown
Sump Pumps
MI=
Foundation Drains
---
=
Roof Drains
cf./
Residential Sanitary Sewer Service
a
Compliance Inspection
Date / / f U
Name j�f� �.S�G
PID Number
House Number
Alternate Mailing Address
1.74 t
For Information call 651.470.2788
r ompliance
o N foundation oun d
ation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection //
Damaged Pipe ( 3
Transition
White Copy: Property Owner
Time
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
'$ 3D ,
4" to 6" Transition: [ g
Disk #
a am
o pm
Street Name
Number of stacks
Yellow Copy: City of Eagan
Record Number
Time
Phone
Inspector Signature
Obstruction
Unable to push past
feet
Length of Service: 1 (.�
Entered S.L. at
2 s
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