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, SEPTIC SYSTEM APPROVAL <br /> flR <br /> _ _0 <br /> - 0 <br /> .CO <br /> o PY <br /> � � <br /> 0 0 <br /> CITY of ORONO <br /> ,� � �.. ,„ <br /> l4 Municipal Offices <br /> �� ' G~ Street Address: Mailing Address: <br /> �`�$Egg04'� 2750 Kelley Parkway P.O. Box 66 <br /> Orono, MN 55356 Crystal Bay, MN 55323-0066 <br /> Owner �pb ��X Phone (Home) (Work) <br /> Address lao9 Fre���,«eek D� City p ro�a State n�Iv Zip <br /> Site Evaluator StQ,,� S�t��,M�rS State License # ��3�y Phone# �63- 4 97- 3 S 66 <br /> Type of Establishment: Single Family_� Multi Family <br /> Commercial Garbage Disposal Yes No <br /> No. Potential Bedrooms 4 Est. Gallons Per Day 60� <br /> Water Meter Required: Yes_ No Soil Sizing Factor <br /> Perc Rates P-1 P-2 P-3 P-4 P-5 P-6 P-7 <br /> Restricting Layer Depth B-1 B-2 B-3 B-4 B-5 B-6 <br /> Type of Treatment System: <br /> Standard�_ Experimental Alternative <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 /> �,�c�-.�`� Septic Tank Size i aSv # of Tanks Lift Tank Size <br /> Pump Brand GPM Head <br /> Treatment System: f����^g <br /> Minimum a y U s� f fi Square Feet with I a inches of rock below pipe <br /> Type of covering Fabric Other <br /> �en.av;� 1q� s� ��, <br /> THIS IS NOT A PERMIT. This is a design approval 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 (952-249-4600) 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 footings will not be granted <br /> until the Inspections Department has verified the primary and alternate sites are protected. <br /> NO VEHICULAR TRAFFIC OF ANY KIND is allowed within 20' of tested drainfield sites ever. <br /> ACCEPTED X DENIED By the City of Orono subject to existing regulations and <br /> the following conditions: R�� :�� a�-�p Sy �T d- �c�o��� 1�� ��-L <br /> �CcG�S< �� 1.a�S� qad:�'.a�. <br /> By: �� 7-��_� 1 <br /> Matt Bolterman, On-Site Systems Manager Date <br /> Telephone(952)249-4600 • Fax(952)249-4616 <br /> www.ci.orono.mn.us <br />