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CITY OF ORONO <br /> ' J Street Address: Mailing Address: Telephone(952)249-4600 <br /> / 2750 KelleyParkwayP.O. Box 66 Fax (952)249-4616 <br /> Orono,MN 55356 Crystal Bay, MN 55323 www.ci.orono.mn.us <br /> Septic System Permit Application <br /> Please complete this applicaton completely. Failure to fill in all of the required information may <br /> result in a delay of processing your application. Submit this application, a complete copy of the <br /> site evaluation and the design at least 3 working days prior to the projected installation date. <br /> Property Owner: Ali HR -C//4/f Email: <br /> Mailing Address: 23cxi ic`s//a /11/9 `. <br /> Phone: Cell: Work: Home: <br /> Designer: bS �,/j -,� License# /v Email: Phone: <br /> Installer/Contractor:$;e,, tic„f License#40 Email:57z,2cratr:y1- Phone:b/- <br /> -e <br /> '/oJ <br /> -e '•v.,,- <br /> Date to be Installed: r"c� . / 7 - / <br /> Property Address: 3-v rvf//o.. <br /> Existing Septic System Eyes: Yes 5 Compliance Inspection Date: <br /> Parcel: (if no address) <br /> General Lot Dimensions: Width: Depth: Total Area: (Acres or sq ft) <br /> Home Type: r #of Bedrooms: . Clothes Washer:/4 Water Cond: <br /> Garbage Disposal: Hot Tub/VVhirpool: Dishwasher: y.5 <br /> Well: Existing New (to be installed) Depth: Size of Casing: Depth of Casing: <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: c:/� - Sizing Factor: f <br /> Septic: New x,� Replacement Addition Other <br /> Tanks: Qty: L New Existing Total <br /> Tank Type ii Capacity Manufacturer AZ ewsi <br /> Pump Station: Tank Type G-r,41,47Capacity J-2 2 Manufacturer e-4.5 <br /> (if applicable) Pump Size 6 hibtP Type 6t.t fi' Failure Alarm Type <br /> Drainfield Total Length T.7 Total Width y` Maximum Depth y <br /> Trenches w/rock Trench w//chambers <br /> Rock below pipe /2- in <br /> Pressure Bed Mound /04(J Other (explain) <br /> Mound Dimensions: Rock Bed //j x 6 3 ft Absorption Area x ft <br /> Clean Fill below rock bed inches <br /> Filter: Type d'.. /,r— Manufacturer Alarm Type: Sc^:-J <br /> New designs shall adhere to 2008 MPCA standards. <br /> OFFICE USE ONLY �i <br /> Permit# oZO/�-p , <br /> D 9j p Payment Rec'd ?/i ,/ Zoning District <br /> Field Checked Date Inspected New/Replace <br />