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.nr , <br /> RECEIVED <br /> a Nov 0 3 2014 CITY OF ORONO <br /> Strut Address: 1 Mailing Address: t Telephone(952)249.4600 <br /> 1 CIT`C';_C rON02750 Kelloy Parkway 11 P.O.Box 66 Fax (952)249-4616 <br /> �{ �' <br /> It es tO <br /> Orono.MN 55356 i Crystal Bay,MN 55323 www.ci,orono.mn.us <br /> tff <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 /> Site Address. ::/0016, �l r l t�0w rivr 5 i,..#-1. (fir ova s <br /> Owner Name: G i«. ti -/s.j y,�tt`e s Address: w .�t <br /> Owner Home Phone: flt - 1 .2: 5 Work Phone: 5,4,"" <br /> Designer: License# 6 d <br /> Designer Address: I S 6K 6 0 t't' <br /> Email: s Iu.N(++.+ ss +br.vKaE Phone:...__q S _` �l7 3 � .................... <br /> Installer/Contractor: License.#. S33 <br /> Installer Address !✓6iriwe Date to be installed: 7 t <br /> Install S •wc. Phone: r _ 7_ - _._.__. <br /> Existin Septic System Eyes: No Compliance inspection Date: 0 <br /> General,Lot Dimensions wdm:2 5'd. .owh, a;S Total Area: (Ac►es oraQ R} / c <br /> Home Type: r` T #of Bedrooms s <br /> 14 eaw water SaRenar✓ Garbage Disposal ir" Not TatuWfarin llishwash�rt/' <br /> Well..Exisftr New (tone iwstatted) Size of Casing: Depth of Casing: <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: sand Sizing Factor: <br /> Septic: New. Replacement Addition X Other <br /> Tanks: Qty: 2 New�_ Existing Total 2000 C,allnnc <br /> Tank Type Concrete , Capacity 2000 Manufacturerand the <br /> Pump Station:Tank Type Capacity Manufacturer <br /> (if applicable) Pump Size Type Failure Alarm Type <br /> Drainfield Total Length_318, Total Width 10 Maximum Depth BC <br /> Trenches w/rock X— Trench w//chambers <br /> v <br /> Rock below pipe F° inches U <br /> Pressure Bed Mound Other(explain) �- <br /> Mound Dimensions: Rock Bed x ft Absorption Area x ft <br /> Clean Fill below rock bed inches <br /> Filter: Type Manufacturer Alarm Type: <br /> New designs shall adhere to 2008 MPGA standards. <br /> OFFICE USE ONLY <br /> Permit# Payment Recd Zoning District <br /> Field Checked Date'lns ected <br /> P New/Replace <br />