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.` <br /> 4 <br /> 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 be installing the following: <br /> A Tanks: _�Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 1ZSU al. 2) 12 al 3) l`,S�O gal <br /> I �o ►3ab <br /> B. Pump Station(if required) <br /> Pump make&model_iJEO�f 1 (Yl (attach pump curve& <br /> literature); system design requires_�2„gpm at 19. feet of head. <br /> High water alarm make&model �FV6�,AQ�'I �,�„)1 . Outside <br /> electrical work to be completed by installer��electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. �_ Mound <br /> Depth of rock below pipe " Rock bed dimensions (� ' x 7 S' <br /> Drop Boxes Sand bed dimensions / Co' x �-I� ' <br /> Distribution Box Pressure Dist. Pipe Diam. � ('2 " <br /> Manifold Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: bonowed 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 all statement mad on this a plication are complete,true and conect. <br /> Signature ofApplicant Date: f y b Z <br /> MPCA License No. ��3 <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Stat�'Review: Approval Denial <br /> Reviewer: "�J I a� Date• � � y —� � <br /> Reason for Denial: <br />