1260 Deerwood Dr - Septic Maintenance Form 2025-08-11t t t
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EAGAN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 buildinginspections(a)_ea aq mmn.gov
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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:
p
Site Address:
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2 R 13 ppX
# of Tanks Pumped:
p
C,> Coo CA � ,- �a
�.,
4 c. r
Total Gallons
Pumped:
_ M A) 47z,
y p
V
Owner's Name:
Owner's Address (if different from site):
Owner's Email: L,A%MG r-c"y„ or- �p_p CCtMCr j+ Owner's Phone
Maintainer's Name: e-X f`Y1. /-,6,Y`A License Number:
Private Residence: X Commercial: Disposal Location: '/ /�G4%� �iY7rpc (� t4 _)
Condition of Baffles: . � Type of Tanks: Lfl Size of Tanks:
Pumped Through:►JA Effluent Sewage Discharge: Yes: No:
Comments:
Name of Person Completing Form: Date:
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Please submit completed forms to the Building Inspections Division via mail or email.