916 Wescott Square - COCd City of E mit
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
I (
4111 City of EaEall
City of Eagan, Minnesota
Property Address: q t 1e W t'SCcr4 S"1(,. (
COMPLIANCE WIIH INITIAL INSPECTION
"his 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
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 n City Plumbing Permit
NOTE: Applicable only if box is checked: OBased on a review of the Sewer Service video inspection /report on file, it is
recommended that periodic cleaning or future inspections beperformed to minimize a potential blockage due to:
Grease Build -up, Root Intrusion, Dip /Settlement in Pipe, Other:
City Approved:
Print name
D t I
Signature Date
White Copy: Property Owner Yellow Copy: City of Eagan (Parcel F He)
rev 2.23 2010