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y <br /> � �oN <br /> � ��� o SEPTIC SYSTEM APPROVAL <br /> y � Street Address: Mailing Address: Te/ephone: (952)249-4600 <br /> `�tq �,� 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: i Z.—]O ��YIC V 1 l.��,4�- � Home Phone: <br /> Owner: �i'l�i'� 1'V�Uf,�^ WorkPhone: 4�'�� �?,�— �,+�,9'Z <br /> Site Evaluator: ' � "��1� xState License# <br /> Site Evaluator Phone Number: �L � $7 — ,3L-�� <br /> Garbage Disposal? Yes No Number of bedrooms: � Est. gallons per day: 7✓r0 <br /> Water meter required? Yes N6 Notes: <br /> TYPE OF TREATMENT SYSTEM <br /> - . Gravity.t�e�ies-s�stem: <br /> Pr eh system: Gravity�ceaebesvaith lift: <br /> Pressurized bed system: � Holdi�tan�k w� .�?larm: <br /> Number of tanks: � Oso Septic Tank Sizes: <br /> Lift tank size: O Pump brand: GPM: Head: <br /> TREATMENT SYSTEM <br /> Minimum: square feet with inches of rock below pipe <br /> Type of covering: Fabric: Other: <br /> SEPTIC HISTORY <br /> Compliance Report attached? YE None <br /> City as-built on file attached? YE No, explain <br /> SITE EVALUATION <br /> YES NO N/A <br /> Soiis 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 soil borin shail 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 showin the followin : <br /> All ro ert lines and lot dimensions <br /> ,/ All existin and ro osed structures <br /> � 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 /> ea <br /> rima nd altemate drainfield areas identified <br /> � ce 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:\septic\septic system approval revised 2-2015.docx <br /> Page 1 of 2 <br />