4259 Beaver Dam Rd - COCCity of Eapa
White Copy: Property Owner
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Fagan, Minnesota
City of Eapa
Property Address: �- 9 f L e 0 P.t w„.._ �Z.a
COMPLIANCE WITH INITIAL INSPECTION
11---T is to certify that the property listed above has been inspected by authorized City personnel on 4' , 201_ 1
and found to be in compliance with Section 3 40 of the City Code and no corrective work was required
COMPLIANCE AF TER CORRECTIVE WORK PERFORMED
n Ihis 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: (Based 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:
City Approved: 1 V'v \ �.. / L Ltk / (0 i D u l -
Print name Signature Date
Yellow Copy: City of Eagan (Parcel File)
rev. 2 23.2010