Loading...
4755 Dodd Rd - Septic Maintenance Form 2022-06-03 4 --------------------- For -------------------- For Office Use �0 I Date Received: EAGAN 1 Staff: I--------------------1 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 1 FAX: (651)675-5694 Plan Submittal:eplansQ_cityofeagan.com SEPTIC SYSTEM MAINTENANCE FORM r Total Gallons Date Pumped: k #- of Tanks.Pumped: �c Pd �'r�;��,'1\ ` r Pumped: Site Address: ��� �� L C:,-a1 Owner's Name: �C--> �ocs Owner's Address(if different from site): Owner's Email: Owner's Phone#:,5c;-) — 5DS— q3 1 GCtiS �1thc� License Number: Maintainer's Name. \J Private Residence: Commercial: Disposal Location: �1y-\ —T� Se L 10(Dc) Condition of Baffles: �'nu n��i Y� Type of Tanks: U%re Size of Tanks: Pumped Through: \y1So,�fc�cx-\ ��k I�Qk _ Effluent Sewage Discharge: Yes: No: Comments: Name of Person Completing Form: Date: 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.citvofeagan.com/subscribe. Please submit completed forms to the Building Inspections Division via mail,fax or email. 6/16/22,1:31 PM Create Pump Log caiumry Create Pump Log Address: 4755 DODD RD, EAGAN, MN 55123 Name: DOUGLAS D &SANDRA L HOPPE Last Pump: 11/9/2007 Gallons: 1000.00 Business I LaRoches Inc Pump Date 06/03/2022 Gallons Pumped 2000 Watertight Tank Yes Waste Backup No Abandoned No Comments FSeptic and drywell serviced. C https://services.co.dakota.mn.us/onlinesepticportal/PumpLogs/Create?business[D=18&septiGsystemlD=25066&screenlD=1111 1/2