3815 Nicols Rd - Septic Maintenance Form 2025-05-223830 PILOT KNOB ROAD | EAGAN, MN 55122-1810
(651) 675-5675 | FAX: (651) 675-5694
Plan Submittal: eplans@cityofeagan.com
SEPTIC SYSTEM MAINTENANCE FORM
Date Pumped: # of Tanks Pumped: Total Gallons
Pumped:
Site Address:
Owner’s Name:
Owner’s Address (if different from site):
Owner’s Email: Owner’s Phone #:
Maintainer’s Name: License Number:
Private Residence: Commercial: Disposal Location:
Condition of Baffles: Type of Tanks: Size of Tanks:
Pumped Through: Effluent Sewage Discharge: Yes: No:
Comments:
Name of Person Completing Form: Date:
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on the City’s website at www.cityofeagan.com/subscribe.
Please submit completed forms to the Building Inspections Division via mail, fax or email.
For Office Use
Date Received:_____________________
Staff: ______________________________