Laserfiche WebLink
11/14/2011 14:23 952-955-5071 BURNS EXCAVATING PAGE 03 <br /> w <br /> Buried Sewer Testing Diagram <br /> Please draw a site diagram of the sewer system and all buried sewer pipes, including those buried beneath <br /> buildings(serving floor drain[s],bathroom[sl,laundry froom,etc.).Please note the portions of the buried sewer <br /> pipes that were pressure tested, the location of the well(s), and major landmarks on the property. <br /> Lvr•� <br /> r\ <br /> (name) — <br /> o%-Gee- b ,certify that the buried sewer(s)des 'bed above is/are <br /> I, <br /> constructed of the indicated,approved sewer material meeting the requirements of the Minnesota Plumbing <br /> and has/have been successfully tested in accordance with Minnesota <br /> Code,Minnesota Rules,part 4715.0530, <br /> Rules,part 4715.2820,by the indicated method. <br /> In accordance with Minnesota Statutes, section 144.992,persons submitting false information to the Minnesota <br /> I)epartment of Health are subject to administrative penalties of up to$10,000. <br /> Nettie Title <br /> S r- t- Yti )76- <br /> Firm <br /> $t=L Add=s <br /> y?d o <br /> state zioP code <br /> City <br /> Mft <br /> T icrppe/Cerdfication <br /> Number signatureDate I <br /> HE-01488.03 origs/aowcr test[vtm.doc <br />