4875 Windsor Ct - Inspection FormAccount # 260536
City of Eagan/City Dept at:
Wayne Schwanz
3419 Coachman Pt
Eagan MN 55122
Service At:
Bill Bierman
4875 Windsor Ct
Eagan MN 55122
Service Date 08/09/10
Description Of Service
PO #
Camera inspection of sewer line.
Camera inspection of sewer line
Check Enclosed [ ] Method of Payment
Master Card [ ] Visa [ ] ArnExp [ ] Discover [ ]
Acct # Exp Date
Name on Catd
Signature
Remit T o:
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
Job # 213283
Quantity
1
Please Detach and Return with Remittance
Invoice #
Date:
Page if
B50853
08/09/10
I of 1
Unit Price Extended Price Tx
$215.00 $215.00
Balance Due $215.00
DUNS #027314893
Ier ms: Due 9/8/2010 Please pay fr om this Invoice, Thank You
Amount Due
Amount Paid
Invoice # B50853
Date :
08/09/10
Account # 260536
City of Eagan /City Dept at:
$215.00
Residential Sanitary Sewer r is
Compliance Inspection
it
Date
Name
PID Number
, I t
(7)
House Number f
Alternate Majling Address
Compliance
a No foundation drain connection
No roof drain connection
'y' Sump pit not connected to
sanitary sewer
0 Sump Pump properly piped
No sump pump
Transition
White Copy: Property Owner
Time
1 ✓S
/.0
Yff d"
Owner /Occupant Signature
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
4" to 6" Transition:
Disk #
/F;
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
` 71
Length of Service:
Yellow Copy: City of Eagan
Record Number
For Information call 651.470.2788
Obstruction
Phone
Unable to push past
feet
Entered S L at
Time
Inspector Signature
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Final Cleanout: ,
o am
o pm
1 ,I
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
=MIMI
Total
Correctly Incorrectly Unknown
Notes
•
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551