904 Lakewood Hills Rd - Septic Maintenance Form 2012-04-09411 City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Email: commdevelopmentAcityofeaqan.com
Date Pumped:
Site Address:
Owners Name:
Maintainers Name: tvs..Vs
Condition of Baffles:
Pumped Through:
Comments:
Owner's Address (if different from site):
SEPTIC SYSTEM MAINTENANCE FORM
Private Residence: Commercial: Disposal Location:
For Office Use
Date Received:
Staff:
Effluent Sewage Discharge: Yes: No:
Type of Tanks: Size of Tanks: Uk)f)
_la
# of Tanks Pumped: Total Gallons Pumped:
License Number:
Please submit completed forms to the Building Inspections Division via mail, fax or email.
DAKOTA COUNTY SEWAGE SY,f.) fEM MAINTENANCE LOG
Pumper Name irikl5 84 MRCA# S Month/Yr Report
Date Pumped: 9 / / .11
Owner: , 3 - esS' S ani eke
No. of laniq Pumped: ) TotalGallons Pumped:I 000
Site Address: 9 40 q 44 / 1 "etzioaj / /4
Owner Address:
MIcipality/Township: CA 0 (AY?
ISPrivate Residence 0 Rental ['Commercial (Owner described type of tank(s) 0 Yes L 4o)
Septage Disposal Location,: $ h. te-k Condition of Baffles: Gend
Type of Tank(s) 1 - ePhz 2 3
(septic tank, holding tank, cesspool, pump tank, sand trap, flammable water trap, etc.)
Size of Tank(s) 1 / 2 3
Pumped through: Man-hole 0 Inspection Pipe Effluent Surface Discharge: D Yes 2
Comments:
Date
Sale No.
4/19/2012
7538
Mike's Septic Service
ce
16961 Mushtown Road
Prior Lake, MN 55372
952-440-1800
Sold To
Gmach, Jessica
904 Lakewood Hills Road
Eau, MN 5512.3-3912
Sales Receipt
Check No.
Payment Method
Project
1807
Chock
Description
Qty
Rate
Amount
Pumping One Septic Tank Manhole
Metropolitan Waste Dumping Charge: $50
Pent* sent to Dakota County
.
1
260.00
260.00
,
Thank you for your business, Cody.
Total $260.00
Mike's Septic Service
ce
16961 Mushtown Road
Prior Lake, MN 55372
952-440-1800
Sold To
Gmach, Jessica
904 Lakewood Hills Road
Eau, MN 5512.3-3912
Sales Receipt