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�°�o SEPTIC SYSTEM APPROVAL <br /> y � Street Address: Mailing Address: Telephone: (952)249-4600 <br /> `� �� 2750 Kelley Parkway PO Box 66 Fax: (952)249-4616 <br /> l�KESH�� Orono, MN 55356 Crystal Bay, MN 55323 www.ci.orono.mn.us <br /> Address: 3� �� �JS.a.h.4-� /`r� �� lt�d4 Home Phone: <br /> Owner: �vs+tcPoD•r�L �� c `��� Work Phone: <br /> Site Evaluator: �'-/� �'i � 7'�� State License# �e .Z 7 <br /> Site Evaluator Phone Number: ZG.�-� 5�'p�3SL� <br /> Garbage Disposal? Yes � Number of bedrooms: '�m"���''�`f Est. gallons per day: � <br /> No�t,.� �'� � <br /> Water meter required? Yes No_ ' Notes: �s� 4 <br /> TYPE OF TREATMENT SYSTEM <br /> At-grade system: Gravity trenches system: <br /> Pressurized �� system: Gravity trenches with lift: <br /> Pressurized bed system: Holding tank with alarm: <br /> Number of tanks: " ��� ,� � Septic Tank Sizes: � J�.�� oZ.�OC3 9�� <br /> Lift tank size: Pump brand: GPM:� Head: <br /> TREATMENT SYSTEM <br /> Minimum: �d, k �i ,7, � square feet with_�inches of rock below pipe <br /> Type of covering: Fabric:�/' Other: <br /> SEPTIC HISTORY <br /> Compliance Report attached? YES Ntone <br /> City as-built on file attached? YES No, explain <br /> SITE EVALUATION <br /> YES NO N/A <br /> Soils 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 /> c/ Relative elevations of house, lot corners 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 /> each <br /> Prima and alternate drainfield areas identified <br /> Distance from primary and alternate drainfield areas to property lines,well locations and any lake, stream, march <br /> or draina e channel within 75 of any art of the se tic s stem. <br /> w:\septic\septic system approval revised 2-2015.docx <br /> Page 1 of 2 <br />