2073 Quartz Lane - COCSANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of Eall
City of Eagan, Minnesota
Property Address: D-01
COMPLIANCE WITH INITIAL INSPECTION
White Copy: Property Owner
City of hp
R "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
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: Based on a review of the Sewer Service video inspectionheport on file, it is
recommended that perio leaning or future inspections be performed to minimize a potential blockage due to:
Grease Build --up, oot Intrusion, Dip /Settlement in Pipe, Other: j 3 5 11aC� RA
City Approved: vV` LLB / \ \ l l Vim` ! f�
Print name Signature Date
Yellow Copy: City of Eagan (Parcel File)
rev 2.23 2010