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SEPTIC SYSTEM APPROVAL <br /> � � 0 <br /> ORONO <br /> COP <br /> o 0 <br /> CITY of ORONO <br /> '�► ' <br /> �(4 Municipal Offices <br /> Street Address: Mailing Address: <br /> `9I;CES140 2750 Kelley Parkway P.O. Box 66 <br /> �- Orono, MN 55356 Crystal Bay, MN 55323-0066 <br /> Owner Phone (Home) (Work) <br /> Address too N, S>`oc., tc _ City 0(00\0 State r^[\/ Zip <br /> Site Evaluator koc,►. Sc:1 'fesr.5 State License # totitul Phone# -? -9 a6 37 <br /> Type of Establishment: Single Family_ Multi Family <br /> Commercial Garbage Disposal Yes ' No <br /> No. Potential Bedrooms 3 Est. Gallons Per Day 4 S U <br /> Water Meter Required: Yes_ Nom Soil Sizing Factor 0.$3 <br /> Perc Rates P-ley P-2 3S.1 P-3 P-4 P-5 P-6 P-7 <br /> Restricting Layer Depth B-1 15- B-2 ao" B-3 11" 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 /> Septic Tank Size \000 # of Tanks Lift Tank Size 100 <br /> Pump Brand GPM 3S Head <br /> Treatment System: <br /> Minimum o x y 17 Square Feet with inches of rock below pipe <br /> Type of co ring 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(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_ DENIED By the City of Orono subject to existing regulations and <br /> the following conditions: A\ko— tk-!" o�- CAN <br /> C)b 'J� -VU C\0/0 Slam dor r-o.,,. vc <br /> By: <br /> Matt Bolterman, On-Site Systems Manager Date <br /> Telephone(952)249-4600 • Fax(952)249-4616 <br /> www.ci.orono.mn.us <br />