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. SEPTIC SYSTEM APPROVAL <br /> O �� ' ► K'S C4PY <br /> � � <br /> � � «�'� <br /> , � ; f,,;,. ,� C ITY of ORONO <br /> E� Municipal Offices <br /> �� � G~ Street Address: Mailing Address: <br /> l,� ' � ��,,;� <br /> kE8H0,-�-'� 2150 Kelley Parkway P.O. Box 66 <br /> — "='" ' Orono. MN 55356 C stal Ba MN 55323-0066 <br /> ___ ��nfv�C��� r�� ll �'-��u,�r�+ rY Y� <br /> _G�"t —L c ,�C <br /> Owner C�h�1��t 5 Cu�ICI CC�. �C C': Phone (Home) :�3,i -�{�� (Work)__ _ <br /> Address_,�� ��,S 1w,-��!/�'�Z�_/��:�" Cin- C_.%1��1';C? State �v"ir1 Zip •-��'"_�� <br /> Site Evaluator 5 -�' ���s�����,� State License .= �`I Phone# N;�7�-.3 5��;6 <br /> Type of Establishment: Single Family� Multi Family <br /> Commercial /�� Garbage Disposal Yes No <br /> No. Potential Bedrooms �/ Est. Gallons Per Day (����'� <br /> Water Meter Required: Yes No� Soil Sizing Factor ,�3 �w5 � �J Ff 2 <br /> Perc Rates P-1� P-2(�� � P-3 J.� P-41, � P-5 y,C' P-6 �7�C; P- <br /> Restricting Layer Depth B-1� B-2,3"1"' B-3 y2'' B-4�E'` B-5 Z<'; ' B-6 3� ' <br /> Type of Treatment System: <br /> Standard x Experimental Alternative <br /> Pressurized Mound System X At-Grade System <br /> Gravity Trenches System Pressurized Trench System <br /> Gravity Trenches W/Lift Pressurized Bed System <br /> Holding Tank W/Alarm <br /> Septic Tank Size j C7�!O # of Ta�s G Lift Tank Size /C�Cx� <br /> Pump Brand -- GPM �i o Head `L�:-` <br /> Treatment System: . �1� � <br /> Minimum ��'�5 s'�� (u zx �»`) Square Feet���ith � inches of rock below pipe <br /> Type of covering Fabric � Other <br /> THIS IS NOT A PERMIT. This is a design appro�al form which must accompany the site plan. <br /> A permit must be issued to a licensed septic contractor prior to installation. <br /> NOTICE TO INSTALLERS: Any changes to the approved plans must have prior approval of the <br /> inspector (249-4600) Call for inspection 24 hours in advance. <br /> ALL DRAINFIELD AREAS MUST BE FE\CED OFF prior to building site excavation and <br /> . fencing must remain in place until final site grading. Approval to pour footings will not be granted <br /> until the Inspections Department has verified the primary and alternate sites are protected. <br /> 1�0 VEHICULAR TRAFFIC OF ANY KInD is allowed within 20' of tested drainfield sites ever. <br /> ACCEPTED_� DENIED B}�the City of Orono subject to eYisting regulations and <br /> the following conditions: � <br /> By: � LC�c:c� /Z—(— �I <br /> ' Pence, On-Site Systems Manager <br /> ��`��� <br /> ,� ��IM�1� <br /> QF- �� <br /> Telephone(612)249--1600 • Fax(612)249-4616 <br />