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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 --------------------- For Office Use I I Date Received: I I I I 1 Staff: I I I 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 ---) - You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeacian.com/subscribe. 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