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4115 Lexington Way - Septic Maintenance Form 2023-10-16--------------------- For Office Use I I Date Received: I I I I I Staff: I I I --------------------- 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 1 FAX: (651) 675-5694 Plan Submittal: eplans�b_cityofeacian.com SEPTIC SYSTEM MAINTENANCE FORM Date Pumped: I # of Tanks Pumped: �% Total Gallons I v Pumped: VylJ Site Address: U i Vv oo Owner's Name: �(,�( G:I Owner's Address (if different from site): Owner's Email: Owner's Phone #: Maintainer's Name: C��-� S License Number: `l Z to - I Private Residence: X_ Commercial: Disposal Location:rn Condition of Baffles: Type of Tanks: \ Size of Tanks: (/ QQ 0— Pumped Through: (,(,(( Effluent Sewage Discharge: Yes: No: Comments: Name of Person Completing Form: /j ? Date: cD You may subscribe to receive an electronic notification fro the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.com/subscribe. Please submit completed forms to the Building Inspections Division via mail, fax or email. 4/ 18/25, 12:23 PM Confirm Pump Log Confirmation! The Below Pump Log Has Been Saved Septic System ID 25027 Parcel ID 102747601010 Address 4115 LEXINGTON WAY, EAGAN, MN 55123 Pump Date 10/16/2023 Gallons 2000.00 Comments Business LaRoches Inc Abandoned No Watertight Tank Yes Waste Backup No Create Date 10/27/2023 12:07:52 PM Home (https://services.co.dakota.mn.us/onlinesepticportal) ❑Email Me This Info © 2023: Dakota County - Online Septic Portal file:///Users/officemanager/Desktop/Pump Logs for DC /4115 Lexington Confirm Pump Log.html 1/1