Laserfiche WebLink
::ECElVED <br /> � �TNIVERSITY �Sl"P As-Built Form NOV 0 4 2013��� ��.....�� <br /> OF MINNESOTA � -�' -- A <br /> CITY OF ORO�JO � �-�..., <br /> :.�...� : � <br /> Ownet: ��c�i^,1^. -f-�:::1'• s��;�. Parcel Number: �_ ' �,� � ::� <br /> Street/City/Zip Code: ���` ��c�:�t t 1�� �,+ �� l��'� ��i ��;',� -,n �_t-,2«1t+.a�3.� `ti (��n�;n's� �-J <br /> _� <br /> Lo� Section: Township: N Range: W <br /> Installation Date: �:.fi /(: fi;, ���; installer: �Jr<<'���Y.� LicenseNumber: l� l 1 :� � <br /> Is the systerr�in Shoreland,serving a MDH facility or in a Wellhead Protection area?❑ YES � NO <br /> Number of 8edrooms/Flow Rate:�!�,? � '-r C��fF':���;^^ #/gpd Sepfic Tanks,No&Sae: � {r�'�`� #/gai <br /> Pump Tank Size: r��`�' �ai Tank Manufacturer: ���'�r�.� ��� Modei# <br /> Dabe of Manufacture: '�'r�'> Maximum 8uriai Depth: �"' ' . <br /> Pump Size: '�? hp gpm ft of TDH �iaats property set?I& YES 0 NO <br /> Saii Treatment Area: <br /> 0 TYPE I 0 TYPE ll ❑ TYPE Ili O TYPE iV 0 IYPE V <br /> 0 TRENCH ❑ BED � MOUND O� AT GRADE❑ WARRANTIED 0 QTHER: <br /> Limit�ng Layer/Depth: " Rockbed Size: '� � ;� �' Oescribe: <br /> Depth from SurFace: " Adsorpfion width: �' '�' � <br /> Rock or Stat depth: " Sand depth: � ` � <br /> �� (under mound) <br /> Diameter of Gravelless: <br /> Trench Width: ft <br /> Bott�m Square feet Area: ftz <br /> Design Variances: <br /> Site Drawin : <br /> Nort Items te be Idenfifi�cl: <br /> 1. Septic,holding and pump <br /> ,-----, #ar�ks,A;Pin�,and saii system <br /> ` � configuration.labet bed or <br /> ``•,-�.�- ` ��r��� ,_ <br /> `�� trench width and fength or <br /> � rockbed size,absorption width <br /> _---_.• �,t, <br /> ` and final dimensions. Indicate <br /> � , `I�.•-}� ( V ) {,1�—.. ��, alarm location. <br /> ;"���'` i�"' ��_.� � 2. Show alt setbacks from tank <br /> { and sal system � <br /> � � a.Property boundries <br /> _ 1�'�ti� b.Buildings <br /> _ 7 �ar�n c� c.We{Is <br /> ✓,,Pt-.`itl'��; � , d.Water bodies <br /> , =� e.Road right-af-way <br /> , � <br /> � �� 3. Improvements-present and o <br /> �, future. � <br /> ' '� �� 4. Berxhmarlc location and a <br /> - distance of tank and soil system � <br /> from benchmark � <br /> c� <br /> 5. Replacement site � <br /> 6. Abandoned system � <br /> Reverse Side � <br />