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� ' SEPTIC SYSTEM APPROVAL <br /> ��,� � �''�.,� �� <br /> O � ; �. � �;� k ' �` �:� <br /> � r... � � ��� , <br /> 7 � <br /> � �Y� �1'��• . '1� � ..M `d.PJ . <br /> o�,, <br /> , o _,; _ ����� <br /> !', �,. � };.�. ,_. �, ,: CITY o� ORO1�0 <br /> �' � ti ji Municipal Offices <br /> ���',� ,`' �,_ G'ti '' <br /> ,t �� �:� ,,' SVe�t Addrzss: M3ilin� Address: <br /> ���`�.�'�����i 2750 Kelley Par��,vay � P.O. Box 66 <br /> Orono, MN 55356 Crystai Bay, h1N 55323-0066 <br /> Owner ��1���55c� ,���?� Phone (Home) (Work) <br /> Address i,3��� j v�r"i�r ��l'��l�4:�.. G)�:. City ��'.��2���� State �� Zip >S s t/ <br /> Site Evaluator n;�, `'�ri;�;��y�f- State License#� Phone# �11`7- /S-!7 <br /> Type of Establishment: Single Family � Multi Family <br /> Commercial /v L _ Gazbage Disposal Yes No <br /> No. Potential Bedrooms . -r Est. Gallons Per Day�� ��?'�l y_i�)�r/S�J <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 X Experimental Alternative <br /> Pressurized Mound System At-Grade System <br /> Gravity Trenches System Pressurized Trench System <br /> Gravity Trenches W/Lift j� Pressurized Bed System <br /> Holding Tank W/Alarm '' �=r%�5+�'r J" <br /> Septic Tank Size /� # of Tanks �-- Lift Tank Size � �`v� <br /> Pump Brand GPM Head <br /> Treatment System: ,r , �l�5S <br /> Minimum h�i�i�`f�'oy r '"1��� Square Feet with 1��' �r`.``^ inches of rock below pipe <br /> Type of covering Fabric � Other <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 (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� DENIED By the City of Orono subject to existing regulations and <br /> thefollow-ingconditions:� /,.,��� ������t �c �'�r� �i�«/ c - /rL` t�<-�T-�rrs,1'�� �ic•.�, /� V�2;N���� <br /> jC' i 1f • �i l(6G.�� 1-a 7>� ' � � L� rcC � <br /> By: , �,� �Ct�,c/ <br /> Chrrs'Pence, On-Site Systems Manager <br /> /�-�` <br /> Telephone(612)249-4600 • Fax(612)249-4616 <br />