4613 Summit Pass - COCCity of 6apn
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eagan, Minnesota
Property Address: ° { �a J S 1 .1rVt N s 4 PG- SS
COMPLIANCE WIIH INIIIAL INSPECTION
--T his is to certify that the property listed above has been inspected by authorized City personnel on , 201_0
and found to be in compliance with Section 3 40 of the City Code and no corrective work was required.
COMPLIANCE AFTER CORRECTIVE WORK PERFORMED
This is to certify that the property listed above has been found to be in compliance with Section 3.40 of the City Code
after satisfactorily completing the required corrective repair work under (check all that apply):
n City Sanitary Sewer Permit Il City Plumbing Permit
NOTE: Applicable only if box is checked :1 Based on a review of the Sewer Service video inspection /report on file, it is
recommended that periodic cleaning or future inspections be perforated to minimize a potential blockage due to:
Grease Build -up, Root Intrusion, Dip /Settlement in Pipe, Others
City Approved:
Print name
White Copy: Property Owner
- e.L .
Signature
Yellow Copy: City of Eagan (Parcel F ile)
Date
41 City of EaR}al
rev 2 23 2010
