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V <br /> 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 the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: Precast Concrete — Other Manufacturer 3P�A� <br /> Tank Capacities: 1) gal. 2) _Lea cgal. ) 12S-o gal. <br /> B. Pump Station (if required) (attach pump curve & <br /> Pump make & model /4 cl. / m at / feet of head. <br /> literature); system design requires � gp <br /> High water alarm make & model ) �L / 0q)A�¢n�.t 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 <br /> Rock bed dimensions AV 'x�' <br /> Drop Boxes Sand bed dimensions.36_'xqQ' <br /> Distribution Box Pressure Dist. Pipe Diam. V' <br /> Maniford Pipe Diam. 2 <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 /> S ignature ofApplicant: <br /> Date: <br /> MPCA Certification No.: 3 9 8 <br /> Staff Review: Approv A Denial <br /> Reviewer: Date: ��' <br /> Reason for Denial- <br />