The URL can be used to link to this page

810 ONeill Dr - Septic Maintenance Form 2022-07-27l t • F t • EAGAN 3830 PILOT KNOB ROAD ( EAGAN, MN 55122-1810 (651) 675-5675 P FAX: (651) 675-5694 Plan Submittal eplans0�citvofeaetan.com --------------------- For Office Use (� I Date Received: (/ 'Z e?�� I I I I I I Staff: I --------------------I SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: ',,tea-' _ - # of Tanks Pumped: Site Address: Lb ��Q �sLga C1 'Y\ U Owner's Name: �% © ¢- Owner's Address (if different from site): Total Gallons Pumped: voryb Owner's Email: �� o �, �� h .� q_,�, M oiArm r Cab vim_ Owner's Phone #: qoS I AS Maintainer's Name: License Number: Private Residence: Condition of Baffles: Pumped Through Comments: Commercial: Disposal Location: C�l e n d Type of Tanks: Pry Size of Tanks: Name of Person Completing Form: �,, �R� Effluent Sewage Discharge: Yes: N 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.citvofeawan.com/subscribe. Please submit completed forms to the Building Inspections Division via mail, fax or email. Awl ewer--iR 5325 MANNING AVE. SO., AFT ON, MN 550-01 �S44 Emily Owned Business Si hm 1976 i eL viv vve r 6 LANAMEYER (651) 459-0162 Liquid Waste Pumped - Portable TojMt and Sirik Renal ?4k - ,- �vvivu eyer-:3"Wo-ancom, Gni pa PUMPED AND BAICKFLUSHED: ---------------- 7 - -Septic Tank �O,Mfffibi.WTank Cesspool Hoiding Tank tuft Station ulstdbtton 0Tj5jnCv0n Box Extra Backf1ushing 7 feet. of hose 'Extra chwge for over 100 fees of hose�) Washington County Fee PUMPED: Sandtrao Sump Other VVeekend or Evening Charge r. REGFBIV�111 SY X TOTALGALLONS: Pumped through rnafiihh'8ie- -'&r inspection pie SepVc tank: PiecPlastic - Unknown Overflovi tank: Precast - Block - Plastic - Unknown Gondition of baff le:.; Good'', Repair Needed, or Unkrojimn-, Drainfield:Moundi.,f�4 or Unknown Effluent surface 6scha06-e: Yesuf Lift 5'6 -tion: Y6§ or No ME Comments: Vw-nwd - Bard -ed ftswed pa