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�°`�o SEPTIC SYSTEM APPROVAL <br /> y � Street Address: Mailing Address: Telephone: (952)249-4600 <br /> `�t,y �,� 2750 Kelley Parkway PO Box 66 Fax: (952)249-4616 <br /> kESHO� Orono, MN 55356 Crystal Bay, MN 55323 www.ci.orono.mn.us <br /> Address: o�yi��3 �o�+��`�ys��e� �,t, �I'� Home Phone: <br /> Owner: �� ��4 �c,�,a,�,�,� '�— �. � ��-��s. Work Phone: <br /> Site Evaluator: I��S X-r D�Se.� State License# <br /> Site Evaluator Phone Number: ��� <br /> 7 <br /> Garbage Disposal? Yes .No Number of bedrooms: _� Est. gallons per day: �o�D <br /> Water meter required? Yes No Notes: <br /> TYPE OF TREATMENT SYSTEM <br /> At-grade system: Gravity trenches system: <br /> Pressurized : />?ma a.aP Gravity trenches with lift: <br /> Pressurized bed system: Holding tank with alarm: <br /> Number of tanks: 3'/am� Septic Tank Sizes: o?� /� DD �� L, <br /> Lift tank size: o d Pump brand: GPM:�� Head: �'`3� <br /> TREATMENT SYSTEM <br /> c. <br /> Minimum: c�4 0 square feet with /oZ inches of rock below pipe <br /> I ype ot covering: Fabric: ✓ Other: <br /> SEPTIC HISTORY <br /> Compliance Report attached? YES No� <br /> City as-built on file attached? YES �, explain IV�*"' S-� J� �o�ik�'�/ <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 soii borin shall be made in the ex ansion area. <br /> Percolation tests <br /> At least two percolation tests shall be completed for each new drainfield site designed. Each percolation test must <br /> be located within the drainfield site or within close proximity along similar contours such that similar soil conditions <br /> are likel . <br /> For additions to existin ISTSs, at least one ercolation test shall be com leted in the ex ansion area. <br /> Plot Plan. A scale drawin of the entire lot showing the following: <br /> All ro ert lines and lot dimensions <br /> All existin and ro osed structures <br /> l All existin or ro osed well locations or water su I i in <br /> � Relative elevations of house, lot comers and drainfield areas <br /> Slo e of round at drainfield sites b contour lines or direction arrows and slo e ercenta es <br /> � Location of all percolation test holes and soil borings with identifying symbols and relative ground elevations of <br /> e <br /> � Prima nd atternate drainfield areas identified <br /> nce from primary and alternate drainfield areas to property lines,well locations and any lake, stream, march <br /> or draina e channel within 75 of an art of the se tic s stem. <br /> w:lseptic\septic system approval revised 2-2015.docx <br /> Page 1 of 2 <br />