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1075 120th St - Septic Maintenance Form 2016-03-11Mar 16 16 01:48p Bob Freiermuth CRI ofEap 3930 Pilot Knob Road Eagan UN 55122 Phone: (659) 675.9875 Fax: (651) 675.5094 Email: commrfevPeloo enpftitvafeaaan.com Date Pumped: Site Address: Owners Name: 6514374327 P.1 i -- –.- ----------– For Deb IRecelvect a o 1 I i scarf I SEPTIC SYSTEM MAINTENANCE FORM 3-11-16 OofTanks Pumped: 2 Total Gallons Pumped: 2000 Dakota County Parks -- Lebanon Hills Maintenance Shop Owner'sAddmss (if different from sits): 1590 Highway 55, Hastings, MN 55033 (Bill _ to:) Maintainer's Name: Bob Freiernuth Sanitation LLC Lla®nseNumber. L492 Private Residence: Commerdal: x_ Disposal Location: Laai2c, AAO. Condhion of 138M 05: �!� Type aF Tanks: /� ciao of Tanks: rr � (J Pumped Through: Effluent Sewage OischaMe: Yes: No: �— commerAs: Flamm submit compiatod forms to the Building inspections Division via maB, fax or emalI.