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• <br /> 4"92)a-3: ° <br /> CITY OF ORONO <br /> R.Ac Matting Addrnsc: TIiophpno(952)249 4600 <br /> 2754 Kelley Parkway I P.O.Box 6b Fax (952}249-4616 <br /> f, w Orono.MdN 55356 ' Crystei Bay,MN 55323 !' www.ci.aronornn.us <br /> Septic System Permit Application <br /> Please complete this applicaton completely. Failure to fill in all of the required information may <br /> result in a delay of processing your application. Submit this application, a complete copy of the <br /> site evaluation and the design at least 3 working days prior to the projected installation date. <br /> pSId19�. , u . <br /> Property Owner:' Email: sr2(1� <br /> Mailing Address: I -! ( l�. �� 1 <br /> Phone: Cell: rk: yome: r r <br /> Designer:,—PlaS hi ' VlC,icense# 0 u'Email:s��Sin .-1-r— ne 7 'Y 17'3.� <br /> Installer/Contractor: r icense#Q(1?Email:pull ' 1 4i ne: 7 b 3 llo . <br /> Kk, <br /> Date to be Installed: •S 00 6 l r1 r (l� Y (� <br /> Property Address: I l 30 1.I S <br /> Existing Septic SystemEyes: <br /> Yes No compliance Inspection Date: <br /> Parcel: (if no address) <br /> General Lot Dimensions: Width: Depth: Total Area: (Acres or sq ft) <br /> Home Type: #of Bedrooms: Clothes Washer: Water Cond: <br /> Garbage Disposal: Hot Tub/Whirpool: Dishwasher: <br /> Well: Existing New(to be installed) Size of Casing: Depth of Casing: <br /> PROPOSED SEPTIC INFORMATION <br /> Soil Types: `/ Sizing Factor: <br /> Septic: New Replacement Addition O er ,,�,, h <br /> Tanks: Qty: I New 300 Existing =S--I OW Total -'I O[ , OO�'4'iti '`�-"'c.• <br /> Tank Type ,apacity Manufacturer <br /> Pump Station: Tank Type • ''. pacity .6 6 Manufacturer rip CIa s-t'cy cFt4 V'.;� C <br /> (if applicable) Pump Size t P1 Type r� = Failure Alarm Type <br /> Drainfield Total Length ' . Total Width Eli Maximum Depth C <br /> Trenches w/rock Trench w//chambers t <br /> Rock below pipe irk( <br /> Pressure BedMand n Other(explain) r <br /> Mound Dimensions: Rock Bed x I,5ft Absorption Area 6 x 4j ft i <br /> Clean Fillbelow rock bed inches <br /> Filter: Type lU Manufacturer N.Ile" Alarm Type: ti f i" <br /> New designs sha I adhere to 2008 MPCA standards. <br /> OFFICE USE ONLY �, �j <br /> Permit#.40/9-' D//25 Payment Rec'd Zoning District <br /> Field Checked Date Inspected New/Replace <br />