Laserfiche WebLink
}�,rm�� � Z��>- �o� i5 <br /> ���o SEPTIC SYSTEM APPROVAL <br /> y� � Street Address: Mailing Address: Telephone: (952)249-4600 <br /> �,y �� 2750 Kelley Parkway PO Box 66 Fax: (952)249-4616 <br /> KFSHO� Orono, MN 55356 Crystal Bay, MN 55323 www.ci.orono.mn.us <br /> Address: " I�-���� ��-L����I��� ���� �( il��_ -� HomePhone: <br /> Owner: Work Phone: <br /> Site Evaluator: State License# <br /> Site Evaluator Phone Number: <br /> Garbage Disposal? Yes? No Number of bedrooms: � Est. gallons per day: ?.�O <br /> Water meter required? Yes No1/ Notes: a���y.�'� �"'`'�9'��"-"',T�ef^1 TS� <br /> TYPE OF TREATMENT SYSTEM <br /> At-grade system: /�o v�� ��i� ��T I Gravity trenches system: <br /> / <br /> Pressurized trench system: Gravity trenches with lift: <br /> Pressurized bed system: Holding tank with alarm: <br /> Number of tanks: �- /3mo 9R.-� Septic Tank Sizes: 1.3m0 9*�1. ..9�/I ����� <br /> Lift tank size: .�D 0 Pump brand: GPM: 3l Head: l�. 2 <br /> TREATMENT SYSTEM � <br /> � �� <br /> Minimum: �:� /��%�� `�-�- ti l l4��« i3�..% L.•:- f>f.,jvL �S square feet with � inches of rock below pipe <br /> Type of covering: Fabric:l/ Other: <br /> R = c o...._. �...� ,q/�.,r.,... �v t -r-ti: �.l�a ��r•.t, <br /> SEPTIC HISTORY � <br /> Compliance Report attached? YES ' None <br /> City as-built on file attached? YES�' No, explain <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 contours such that similar soil conditions are <br /> likel . <br /> For additions to an ISTS, at least one soil borin <br /> Percolation tests <br /> � At least two percolation tests shall be completed �n test must <br /> be located within the drainfield site or within close conditions <br /> are likel . /� �� s��,f �?•Gv-s � <br /> For additions to existin ISTSs, at least one erc� �o�o <br /> Piot Plan. A scale drawin of the entire lot show r <br /> All ro ert lines and lot dimensions / ��wGL� �� ,�.... <br /> All existin and ro osed structures �9 'G <br /> f All existin or ro osed well locations or water su <br /> ✓ Relative elevations of house, lot corners and drair � � ��„�.�- `J <br /> ✓ Slo e of round at drainfield sites b contour line; !�� <br /> � Location of all percolation test holes and soil borir �ons of <br /> each �5,�}'G�� <br /> Prima and alternate drainfield areas identified <br /> _ / Distance from primary and alternate drainfield are n, march <br /> V or draina e channel within 75 of an art of the se <br /> w:\septic\septic system approval revised 2-2015.docx <br /> Page 1 0 <br />