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SEPTIC SYSTEM YAL <br /> t U <br /> CITY of ORONO <br /> Municipal Offices <br /> Street Address: Mailing Address: <br /> kESITO 2150 Kelley Parkway P.O. Box 66 <br /> Orono, MN 55356 Crystal Bay, MN 55323-0066 <br /> Owner C ck r o(yn 10-z a Sk• Phone (Home) (Work) <br /> Address x{05 O 1 d Cc y S0 5 City State Zip <br /> Site Evaluator Ste.,k. State License # 617 Phone# -M- 49-7-3 <br /> Type of Establishment: Single Family X Multi Family <br /> Commercial Est. Gallons Per Day 4 S O <br /> No. Potential Bedrooms 3 Slope: 3 010 <br /> Depth of Sand: Upslope: Downslope: Soil Sizing Factor D.0 U <br /> Perc Rates P-1 -).5 P-2 6 P-3 5,Z P-4 3.4 P-5 P-6 P-7 <br /> Restricting Layer Depth B-1 $" B-2 ' 4" B-3 14" B-4 36" B-5 B-6 <br /> Type of Treatment System: <br /> Standard Alternative Other Performance X <br /> Pressurized Mound System At-Grade System <br /> Gravity Trenches System Pressurized Trench System <br /> Gravity Trenches W/Lift Pressurized Bed System_ <br /> Holding Tank W/Alarm <br /> Septic Tank Size 1 Soo cv�w # of Tanks I Lift Tank Size SOy d- 500 <br /> Pump Brand GPM d1S d- y"3 Head J� I y <br /> Treatment Stem: ' L i Z <br /> Minimum ;°y Square Feet with t D, inches of rock below pipe <br /> Mound Bed Mound Treatment Area <br /> THIS IS NOT A PERMIT. This is a design approval form which must accompany the site plan. <br /> A permit must be issued to a licensed septic contractor prior to installation. <br /> NOTICE TO INSTALLERS: Any changes to the approved plans must have prior approval of the <br /> inspector(952-249-4600) Call for inspection 24 hours in advance. <br /> ALL DRAINFIELD AREAS MUST BE FENCED OFF prior to building site excavation and <br /> fencing must remain in place until final site grading. Approval to pour footings will not be granted <br /> until the Inspections Department has verified the primary and alternate sites are protected. <br /> NO VEHICULAR TRAFFIC OF ANY KIND is allowed within 20'of tested drainfield sites ever. <br /> ACCEPTED K DENIED By the City of Orono subject to existing regulations and <br /> the following conditions: necJ a,. 4x- jy. des; \. <br /> lr\=5 -� S - <br /> r k%(TtN. <br /> _.•.i t,�(��,,� �c. r~0�!�� `�- r�C t .$ Fo 4 :S X12�C� . <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 />