4755 Dodd Rd - Septic Maintenance Form 2022-06-03 4
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For
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For Office Use
�0 I Date Received:
EAGAN
1 Staff:
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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:
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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