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1350 Rocky Lane - Septic Maintenance Form 2021-07-30EAGAN 3830 PILOT KNOB ROADS EAGAN, MN 55122-1810 (651) 675-5675 1 FAX: (651) 675-5694 Plan Submittal: eprans(Jcityofeaaan.com Date Pumped Site Address: Owner's Name: For Office Use Date Received Staff SEPTIC SYSTEM MAINTENANCE FORM 7'30faOQ I35o gar # of Tanks Pumped: a Total Gallons Goo Pumped: Owner's Address (if different from site): Owner's Email: tA1.1 i� 10,r S q (YLGt t1 . cow Ownerys Phone #: D " ()Id, - 3 3"L/ Maintainer's Name: Alp Set-4R r Se(1a�-l?ry1S) License Number: Private ResidenceCommercial: Disposal Location: Condition of Baffles: Type of Tanks: Size of Tanks: COD Sco Pumped Through: Effluent Sewage Discharge: Yes: No: Comments yy ++ II__ , { ` rr J Oi0(1!' kpve_ �I1e ntbcAkt 'd orMOt�(6ft, U(-4� �(+'14,cnied 4 cap 0-c Oct ,l)iJo C4 k Ylc>Lr'_� cancerr,S Jars ,pur�'tp of 4...Laks Name of Person Completing Form: IA); II 1.ZlC5 .."1. Date 1�Yldo0?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.citvofeapan.comisubscribe. Please submit completed forms to the Building Inspections Division via mail, fax or email. ALTO SEWER SERVICE (612) 822-5345 1061 Cliff Road East Burnsville, MN 55337 INVOICE PO# Bill to: it So r--} Service Address: Phone # Date: Start Time: Apartment # End Time: Tech: ,J t2,•-',..f 15 Work Performed: 5-Oa ?J5 ' All footage noted is approximate Warranty Commencing from 20 Amount $ Tyr *Foreign objects void all warranties* Payment: 0 CASH ❑ Check# ❑ Net 30 Days O.A.C. 131 VISA p MC 0 AMEX ❑ DISC cc# „� ? (-7;eY -' Exp 9 Ref el 9 Z AP The wort 9aning equipment and methods. It is mutually agreed that Alto Sewer Service shall not be held responsi. wn lead piping. improper or faulty plumbing, settled, broken, damaged, rusted, defective pipe, corrosion or omer unusuar resmcnons oue to rye or other cleaning chemical operations or installation, and if, during the cleaning process, any damage results from such tines or any fixtures are damaged or broken, the company shall not be liable for the repairs to or the replacement of such damage or fixtures. Alto Sewer Service will not be held responsible ii equipment becomes lodged in defective tiles, pipes, or plumbing. The company will not be liable for repair, replacement, or excavation of such fixtures. Any' repair, replacement, or excavation to said pipes shall be done at the expense of the owner. The company shall not be held liable for water or any other damage that may result in the interim- This contract covers only the items listed above under the existing plumbing arrangement. If any additional work is required, the company shall reserve the right to alter the price of the contract commensurate with the changes made. If it is found that a clean out, drain cover, or trap is so rusted or fastened so as to necessitate replacement atter it is removed, it is understood that said replacement shall be made at an additional cost for the cover or trap only. Alto Sewer Service will attempt to gain access to the source of the incident with as little disturbance as possible. However, please note that it may be necessary to remove, open or break tiles, floor, ceiling, or wall coverings to gain access 10 the source of the incident which has given rise to your service call. By signing this form you agree that Alto Sewer Service shall not be held responsible for any direct or indirect costs, loss or damage as a result of damage to your property caused to gain access to the cause of the incident. This instrument embodies the whole agreement of the parties, there being no promises, terms, conditions, or obligations referring to the subject matter other than contained herein and is subject to the owners credit. I confirm that I have read and understood the above and that by signing below I agree that Alto Sewer Service may carry out the required work to attempt to restore my plumbing to working condition. Work Authorized By: X Date 7-3v-Zoz 'All invoices must be paid within 30 days of job completion if OAC or a 1.5°i per month office tee will be added.