3910 Blackhawk Rd - COCCity of Eapll
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City Approved: i v■. 1 / .ti- VA-C, r /
Print name Signature
Yellow Copy: City of Eagan (Parcel F ile)
Date
4 City of Eapa
City of Eagan, Minnesota
Property Addyess: S" 1J �C���� teO
COMPLIANCE WITH INITIAL INSPEC TION
This is to certify that the property listed above has been inspected by authorized City personnel on °" , 201
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
n 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 City Plumbing Permit
NOTE: Applicable only if bo.x is checked: nBased on a review of the Sewer Service video inspection /report on file, it is
recommended that periodic cleaning or future inspections be performed to minimize a potential blockage due to:
Grease Build -up, Root Intrusion, Dip/Settlement in Pipe, Other
rev 2 23 2010