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SEPTIC SYSTEM APPROVAL <br /> ORO <br /> o car <br /> 0 0 <br /> a ,r <br /> CITYofORONO <br /> vt, iL �� Municipal Offices <br /> 1, <br /> .�" Street Address: Mailing Address: <br /> 414rassgOi' 2750 Kelley Parkway P.O. Box 66 <br /> Orono, MN 55356 Crystal Bay, MN 55323-0066 <br /> Owner t o Ke t 6 r Phone (Home) 476-)sot 6 (Work) <br /> Address 74o 0: 0,c4 PafK RJ City 0 Coco State N,iv Zip ccs-C <br /> Site Evaluator gob vo\Ke,4„fi State License# S6 Phone# <br /> Type of Establishment: Single Family X Multi Family <br /> Commercial Garbage Disposal Yes No <br /> No. Potential Bedrooms 3 Est. Gallons Per Day 4 S() <br /> Water Meter Required: Yes_ No X Soil Sizing Factor I. 5 <br /> Perc Rates P-1 10 P-2 11y P-3 S•-1 P-4 73 P-5 P-6 P-7 <br /> Restricting Layer Depth B-1 lc,” B-2 ay" B-3 ay'' B-4 I`' B-5 IL" B-6 u." <br /> Type of Treatment System: <br /> Standard )C Experimental Alternative <br /> Pressurized Mound System X 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 I o o 0 # of Tanks a Lift Tank Size I oo 0 <br /> Pump Brand GPM SI Head 35 .teen <br /> Treatment System: <br /> Minimum(I o x 67)04 x 4 I) Square Feet with \ inches of rock below pipe <br /> Type of covering 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 X DENIED By the City of Orono subject to existing regulations and <br /> the following conditions: .S •S d q cc s i.ec) 1a' a a(b o,.. he oS C . P u n,1 a <br /> ccvS�, o �c"\CS . <br /> By: MY\00& -15 - oI <br /> Matt Bolterman, On-Site Systems Manager Date <br /> Telephone(952)249-4600 • Fax(952)249-4616 <br /> www.ci.orono.mn.us <br />