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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> � 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will �e installing the following: � - f'�-o I d i � � I/}�K s <br /> A. Tanks: 2 Precast Concrete Other Manufacturer� �� � �5 <br /> Tank Capacities: 1) � 6 SO gal. 2) b5b gal 3) gal <br /> B. Pump Station(if required) <br /> Pump make& model (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by installer �C electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, <br /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota,and certifies that al tatements made on this application are complete,true and correct. <br /> Signature ofApplicant � Date: �"� -� �d 7 <br /> MPCA License No. � - �3� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> �v enial <br /> Staff Rev�ew: Approval D <br /> Reviewer: ��� Date: ���'/�-�� <br /> � <br /> Reason for Denial: <br /> �v T� C'C) /V�tln1�,.� v/� p c q� f Q C A r� ,` r,��'�r A �R<n.. <br /> W A-r � I1��2�k CS Z C� G��ir�C c�� �� t ., y� 6.ef �� s� i� S i �� � � <br /> �;yh� A^ � s°`_^� A � ,� ��"� �ro r3a ..�.. s�r�A t( e � c'� ts c�� <br /> i� t3.J ; � c�;�� � =r-,.�' /+•���.-,�.�a t c..�� .,+cr Ae t,u, +v:_._ <br /> Si� �...� A 7 P Tc�l� �� c� 5 � c��S �� T l�i� tC Sd <br />