1244 Deerwood Dr - Septic Maintenance Form 2022-06-16EAGAN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
Plan Submittal: eplans(cDcitvofeagan.com
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For Office Use
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Date Received:
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1 Staff: I
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SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: Lp— l (e a� # of Tanks Pumped:
Site Address: 1.1 q q �.J� E' i C�?C�C� f , -QQ
Owner's Name: 't' �1 �' ��lC'� n sU n
Owner's Address (if different from site):
Owner's Email:
Total Gallons
Pumped:
I s ov
Owner's Phone #: 1, 10-1 `-1 rl 6 — `J q I
Maintainer's Name: ® JE'JZ`� 0/ t �Yi Y� ' ' C License Number:
%t
Private Residence: Commercial: Disposal Location: �YY� `� \y-te-.
Condition of Baffles: c+ Type of Tanks: t" ' L Size of Tanks: I g,
Pumped Through: Ve�,-e.A 'on%qEffluent Sewage Discharge: Yes: No:
X, Cemr•
Comments:
Name of Person Completing Form: �� Ic"R06"z— Date:
t L a ---) -
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Please submit completed forms to the Building Inspections Division via mail, fax or email.
7/8/22,1:25 PM
Edit Pump Log
Address: 1244 DEERWOOD DR, EAGAN, MN 55123
Name: DAVID W $ SHERYL B JOHNSON
Last Pump: 6/16/2022
Gallons: 1500.00
Business
LaRoches Inc
Pump Date
L06/16/2022
Gallons Pumped
1500.00
Watertight Tank
F Yes
V1
Waste Backup
No
Abandoned
No
Comments
Edit Pump Log
Serviced the septic tank through a level center maintenance manway. Noted plastic baffles intact.
https://services.co.dakota.mn.us/onlinesepticportal/PumpLogs/Edit/33893 1/2