3505 Trails End Rd - Septic Maintenance Form 2022-06-16EAGAN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
Plan Submittal: eplans a)cityofeagan.com
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For Office Use
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Date Received:
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I Staff: I
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SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: (,,.,- j (0 • # of Tanks Pumped:
Site Address: �,� ` r �`S �� 1C0�C'
Owner's Name: C
Owner's Address (if different from site):
Owner's Email:
\C-_> VAre r
Total Gallons
Pumped: l ��
Owner's Phone #: (91 �--1 "- q _l-7 ~ 94 17
Maintainer's Name: �X S C� ,YCa�Y1'� License Number: v�
Private Residence:_ Commercial
Condition of Baffles:
Pumped Through:
Comments:
Disposal Location: E'M () i r
Type of Tanks: �)Q� t-- Size of Tanks: loco
LI ��c�Yl \(
+Y 59C -c I3 Effluent Sewage Discharge: Yes: No: (`
cky u w -e k
-sgo-\�, -k-cVX aA W " 'F_�cury-\ G_\ -\A cS S6�4L
Name of Person Completing Form: V��� ux� Date: LP — kLo
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Please submit completed forms to the Building Inspections Division via mail, fax or email.
7/8/22,1:24 PM
Edit Pump Log
Address: 3505 TRAILS END RD, EAGAN, MN 55123
Name: SCOTT D & CYDNEY A WELTER
Last Pump: 6/16/2022
Gallons: 1000.00
Business
LaRoches Inc
Pump Date
06/16/2022
G
Gallons Pumped
i 1000.00
l_
Watertight Tank
FYes
i
Waste Backup
No
Abandoned
No�
Comments
The tank had a great deal of sludge present.
Edit Pump Log
https://services.co.dakota.mn.us/onlinesepticportal/PumpLogs/Editt33894 1/2