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NOTE: -Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system design including <br /> Septic System Approval Cover Sheet. the City of Orono <br /> .2. I will be installing the followin?: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) �) gal. 3) gal.* <br /> B. Pump Station (if required) <br /> Pump make & model - (attach pump curve & <br /> literature); system design requires Q <br /> High water alarm make & model aPm at feet of head. <br /> • J ,s ��. Outside <br /> • electrical work to be completed by installer electrician <br /> other Inside electrical work must be completed by <br /> electrician. <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 /> Maniford 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 <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct: <br /> SignatureofApplicant: <br /> Date:_ <br /> MPCA Certification No.: <br /> Staff Review: *Appry e *alReviewer: <br /> Date:Reason for Deni <br />