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� SEPTIC SYSTEM APPROti'AL <br /> � �� � � <br /> � <br /> 0 0 �Q <br /> _ � <br /> =;�{��.f�..� � �, CITY of OR011T0 <br /> ��,� �� -, � � <br /> .�`� <br /> � ��` �, � Municipal O�ces <br /> �,'�' ,- ', , '��� <br /> �� � ! `�' `�° G Street Address: Mailing Address: <br /> ���� `:+�„� <br /> �EsHp 2150 Keiley Parkway P.O. Box 66 <br /> Orono, MN 55356 Crystal Bay, MN 55323-0066 <br /> Owner �eoRG F �-�����e� e Phone (Home) (Work) �(7b—36%y <br /> � <br /> Address����- Oc-� �"v��5��'�� ��'= ���_City State Zip <br /> Site Evaluator D/t E��-�����n State License# (9Y�f Phone# L'� 7 - 3v�$ <br /> Type of Establishment: �ingle Family�_ Multi Family <br /> Commercial Garbage Disposal Yes No <br /> No. Potential Bedrooms �( Est. Gallons Per Day �O�i <br /> Water Meter Required: Yes_ No� Soil Sizing Factor - �3 <br /> Perc Rates P-1 � P-2 P-3 P-4 P-5 P-6 P-7 <br /> Restricting Layer Depth B-1 ?o" B-2 (4" B-3 28" B-4 2G° B-� B-6 <br /> Type of Treatment System: <br /> Standard_� Experimental Altemative <br /> Pressurized Mound System � 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 /i�O v # of Tanks 2- Lift Tank Size 125D <br /> Pump Brand GPM �� Head (�-{ <br /> Treatment System: <br /> Minimum �, 0 v Square Feet with � inches of rock below pipe <br /> Type of covering Fabric C_ Other <br /> THIS IS NOT A PERNIIT. This is a design approval form which must accompany the site plan. <br /> A pernut must be issued to a licensed septic contractor prior to installation. <br /> NOTICE TO INSTALLERS: Any changes to the approved plans must ha�-e prior approval of the <br /> inspector (249-4600) Call for inspection 24 hours in advance. <br /> ALL DRAINFIELD AREAS MUST BE FENCED OFF prior to building site excavation and <br /> . fencing must remain in place until final site grading. Approval to pour footinjs will not be granted <br /> until the Inspections Department has verified the primary and alternate sites are protected. <br /> NO VEHICULAR TRAFFIC OF ANY HIND is allowed within 20'of tested drainfield sites ever. <br /> ACCEPTED_� DE1vIED By the City of Orono subjec�to e�isting regulations and <br /> the followulg conditrons: <br /> � <br /> � <br /> By: ��w ��i <br /> Chns Pence, On-Site Systems Manager <br /> Telephone(612)249-4600 • Fax(612)249-4616 <br />