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�v o f�� I��^� �r������ <br /> �°'�o SEPTIC SYSTEM APPROVAL <br /> y � Street Address: Mailing Address: Te/ephone: (952)249-4600 <br /> `� �� 2750 Kelley Parkway PO Box 66 Fax: (952)249-4616 <br /> �qkFSHo� Orono, MN 55356 Crystal Bay, MN 55323 www.ci.orono.mn.us <br /> Address: ��J .)�1 t�l}(;�,.�( �; ��(,�_ = Home Phone: <br /> Owner: Work Phone: <br /> Site Evaluator: Ru s -..� � �Je.� State License# <br /> Site Evaluator Phone Number: 7 L 3 — `{p8� �774 <br /> Garbage Disposal? Yes No� Number of bedrooms: _ � Est. gallons per day: _73a <br /> Water meter required? Yes No Notes: <br /> TYPE OF TREATMENT SYSTEM <br /> At-grade system: /h D ua,r�_ Gravity trenches system: <br /> Pressurized trench system: Gravity trenches with lift: <br /> Pressurized bed system: Holding tank with alarm: � /.3ao <br /> Number of tanks: 3 Septic Tank Sizes: �3 Do,, f /�OO <br /> Lift tank size: 3oD Pump brand: GPM: Head: <br /> TREATMENT SYSTEM a � `� <br /> Minimum: �Ox'(.�r �s�d square feet with (p inches of rock below pipe <br /> Type of covering: Fabric: ✓ Other: ���� �,Q„�O,v�.,0� �q�,� <br /> SEPTIC HISTORY 7��Y��s ��t��""'� <br /> ._..T�"� <br /> Compliance Report attached? YES None� <br /> City as-built on file attached? YES No, �xplain � �;�1�� �� <br /> .� <br /> SITE EVALUATION <br /> YES NO N/A <br /> Soils borin s. <br /> / At least three soil borings shall be completed for each new drainfield site designed. Each soil boring must be <br /> / located within the drainfield site or within close proximity along similar conto��rc� similar soil conditions are <br /> likel . <br /> For additions to an ISTS, at least one soil borin sha" ` <br /> Percolation tests <br /> / At least two percolation tests shall b� h percolation test must <br /> be located within the drainfield site oi � similar soil conditions <br /> are likel . <br /> For additions to existin ISTSs, at lea: , ( �`f w� "� ion area. <br /> Plot Plan. A scale drawin of the entii ����� 3 ' <br /> All ro ert lines and lot dimensions �t w� <br /> All existin and ro osed structures � � � ��' <br /> All existin or ro osed well locations or 1 �'��G <br /> Relative elevations of house, lot comers. ��� ,� � ,t !yf UtO <br /> Slo e of round at drainfield sites b cont £,r r'�-` <br /> Location of all percolation test holes and s ���_ � elevations of <br /> each <br /> Prima and alternate drainfield areas ideni <br /> / Distance from primary and alternate drainfie ;tream, march <br /> or draina e channel within 75 of an art of, <br /> w:\septic\septic system approval revised 2-2015.docx <br /> Pag <br />