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995 Cliff Rd - Septic Maintenance Form 2023-11-02EAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 1 FAX: (651) 675-5694 Plan Submittal eplans(a?citvofeagan.com --------------------- For Office Use I I Date Received: I I I I I Staff: I I I SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: / �� �2 3 # of Tanks Pumped Site Address: l j l �/-&�_ i L a Owner's Name: 41&"- ` Owner's Address (if different from site): Owner's Email: Al"X Total Gallons 1566 Pumped: M /L� -123 psi y� y- yg V� Owner's Phone #: —6-5-1 Y5 1 _ 419 `I4 Maintainer's Name: ' ' /eye ��y�G�'- License Number: Private Residence: V Commercial: Disposal Location: Condition of Baffles: Pumped Through: Comments: Type of Tanks: Size of Tanks: Effluent Sewage Discharge: Yes: Oot- a uaz-bi,& 0 No: Name of Person Completing Form:��lr�Q2� �'� dL�iLP� Date: /2 3 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.citvofeauan.com/subscribe. Please submit completed forms to the Building Inspections Division via mail, fax or email. eyer-a PO BOX 40 AFTON, MN 55001 55 ewer 4 Family Owned Business Since 1976 ervice Q (651) 459-0162 www.MeyerSewer.com CASH CMAR E CREDIT CARD CHARGES PLEASE CALL DATE( j l E ,,.% J r�0� CKFLUSHED: Cesspool Holding Tank Sump Cleaned Filter Used Crust Buster to break up thick crust Extra Backflushing �� feet of hose (Extra charge for over 120 feet of hose) County Fee or City Fee Disposal Fee CRIER REPAIRS: Weekend or Evening Charge TOTAL GALLONS: r TOTAL r .' COMMENTS: <_ B& iEr RECEIVED BY: Llwneod•Bonded •/neured I'censeo by the Mlnne�,nlu Pollution Contrail Agenvy PeiNo: