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CITY OF ORC D <br />SEPTIC SYSTEM DESIGN PROPOSAL <br />STANDARD REPORT FORM <br />"DIE: This fors ■u- be completed by the applicant or his agent and submitted for approval with all re- <br />quired attachment en building permit is applied for. The following exhibits are required as a part of <br />this applicatior. - shall be attached hereto: Percolation lest logs and Soil Boring Logs (on standard <br />forms); Site Plan drawn to scale showing locations of existing and proposed buildings. lot lines. perco- <br />lation test and soil boring hole locations. proposed system location and layout. and well location. THE <br />HOUSE AND ORAINFIEL0 AREA MUST BE STAKED. Improper or inadequate soil testing or information will result <br />in delays in processing. Permits will be issued only to contra..tors holding a currant Orono Septic Sys. <br />tem Installers License. <br />TYPE OF WORK: MNEW CONSTRUCTION ❑ ADDITION OR REPAIR ❑ SU01VISION APPROVAL ONLY <br />PINS NUMBER_W- �`��% IINIC)C' C=�"i,ROPERTY I)DRI1SS Z�� <br />PROPERTY DF5CRIP- `- � L CL�:'!<- / l�/!L f-ti.L 2S rsx-sr <br />OWNER -�� .fit<ac'*, 1�1L+C ��pitt.�IL<LLw� i\75-3\�e3 <br />'Fiai.r /�— ail�Xddi;•s "—'11 gone <br />SITE EVALUATOR &c�t=y iC. l,7TC� u !tip <br />ame - at dress —Eity one <br />GENERAL CONTRAC70 t`A`F t- 7�y <br />:aF a� ress Lty Phone <br />SYSTEM INSTALLER KNOW!.''% 1�thiy t�� L\%'� - WA-4 C ` <br />THE INFORMATION BETAW MUSS BE FILLED IN BASED ON THE SITE LVALUATION AND DESIGN REPORT (ATTACH). <br />1. SITE EVALUATION / DESIGN CRITERIA USED _ Ltd Q Z '3� <br />NO. OF BEDROOMS 3 GALLONS PER DAY \Sl PERC RATE_ �J KNINUTE PER INCH <br />I u <br />INDICATED DEPTH TO SEASONAL WATER TABLE OR SATURATED ZONE <br />2. SEPTIC TANKS <br />TANK I 1 :`KC) _GAL. MIN. LIQUID CAPACITY <br />TANK N 2 tj��GAL. MIN. LIQUID CAPACITY <br />3. PUMP STATION milSe-tn. 12 <br />MANHOLE TO 6-12" BELOW FINAL GRADE, INLET AND <br />OUTLET INSPEC71ON PIPES TO SURFACE REOUIREP ON <br />ALL SEPTIC TANKS. <br />®NOT REQUIRED REO1,1.40 GAL. MIN. CAP T1 (TO ALLOW FOR 1 DAY :TE`FA(E L PACITY) <br />S WAG EJECTOR (BEFORE SEPTIC TANKS) <br />,VfFFLUENT ONLY (AFTER SEPTIC TANKS) CHECK VALVE TO BE USED ❑ YES An <br />NIGH WATER ALARn AND MANHOLE TO SURFACE REQUIRED ON ALL PUMP STATIONS. <br />4. MINFIELD SYSTEM TRENCHES ❑ PRESSURE DIST11T.UTION MOUND ('J OTHER: <br />ATTACH INFORMATION <br />'PENCHES: ❑ DISTRIBUTION P [".u? b'. SO. FT. BOTTOM AREA 1 �Cf1 th <br />TRENCH WIDTH (3 MAX.' T. tR-TO-CENTER TRENCH SPACING 1 Z FT. <br />DEPTH OF ROCK BELOW Tit } Z ff Q " <br />INCHES DEPTH CF ROCK OVER •_E (2" MINA <br />DEPTH OF TRENCH BELOW OR) _ iURFACE1T''2 4- INCHES FINAL COVER(8" Mih.,24" MAX.) INCHES <br />NUMBER OF LINES !A__ LENGTH OF EACI, LINE S <br />PRESSURE DISTRIBUTION MDUND: ❑STAND' . +F' .:N AS PER URUNO DESIG.i ilANUAL <br />❑ OTHER <br />SAND BASE DIMENSIONS: LENGTV FT. x ,FT. WIDTH SAND DEPTH BELOW ROCK._ INCHES <br />ROCK BED DIMENSIONS: STANDARD 10 FT. WIDTH X FT. LENCTM S%OPL AT SITE <br />FOR OFFICE USE ONLT <br />*"gAPPROVED AS PROPOSED ❑ AVPRDVED WITH CHANGES NOTED BELOW ❑ A. 11AL ITEMS NEEDED NOTEC BELOW <br />APPROVED BY: DATE <br />_..%� <br />