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SEPTIC SYSTEM APPROVAL <br /> Street Address: Mailing Address: Telephone: (952)249-4600 <br /> A� 2750 Kelley Parkway PO Box 66 Fax: (952)249-4616 <br /> F G� Orono, MN 55356 Crystal Bay, MN 55323 www.ci.orono.mn.us <br /> �gkFSHo�<` <br /> Address: 4�0 'A h. Q C-2 12 <br /> 2 o vim✓ Home Phone. <br /> Owner: Work Phone: <br /> Site Evaluator: D S E V A So State License# 'F/e� <br /> Site Evaluator Wone Number: '7l3 f c4'-cv77 <br /> TYPE OF ESTABLISHMENT Single Family: Multi-Family: <br /> Commercial? Yes No Garbage Disposal? Yes No <br /> Number of bedrooms: i /'" Est. gallons per day: <br /> Water meter required? Yes No Soil sizing factor: <br /> Perc Rates: <br /> P-1 ,,�.{. P-2 YL /i— P-3 — P-4 — P-5 — P-6 — P-7 <br /> Restricting layer depth: <br /> B-1 B-2 B-3 B-4 B-5 — B-6 <br /> TYPE OF TREATMEJNT SYSTEM <br /> Standard: rx f 5 lel � Experimental: Alternative: <br /> Pressurized mound system: ;/ At-grade system: <br /> Gravity trenches system: Pressurized trench system: <br /> Gravity trenches with lift: Pressurized bed system: <br /> Holding tank with alarm: <br /> Number of tanks: Septic Tank Sizes: 1.3670 .0- /3 " c' <br /> Lift tank size: 1:3o o Pump brand: / / GPM: Head: <br /> TREATMENT SYSTEM <br /> Minimum: square feet with inches of rock below pipe <br /> Type of covering: Fabric: Other: <br /> THIS IS NOT A PERMIT. This is a design approval form which must accompany the site plan. A permit must be <br /> issued to a licensed septic contractor prior to installation. <br /> NOTICE TO INSTALLERS. Any changes to the approved plans must have prior approval by the inspector. Call for <br /> inspection 24-hours in advance. <br /> ALL DRAINFIELD AREAS MUST BE FENCED OFF prior to building site excavation and fencing must remain in <br /> place until final site grading. Approval to pour footings will not be granted until Inspections Department has verified <br /> the primary and alternate sites are protected. <br /> NO VEHICULAR TRRAFFICE OF ANY KIND is allowed within 20' of tested drainfield sites ever. <br /> ACCEPTED DENIED by the City of Orono subject to existing regulations and the following <br /> conditions: <br /> oti //v5 <« i u w 0 - oCi✓ S' vc <br /> By: Date: <br /> Printed Name: <br />