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V <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> AI1. 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 installincr the following: <br /> A. Tanks: %recast Concrete Other Manufacturer EU S <br /> Tank Capacities: 1) rz 50 gal. 2) /o0Ogal 3) 12SO 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 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 all statements ade on this application are complete,true and correct. <br /> ter.-< <br /> r . <br /> SignatureofApplicant /-� •"1112111 Date: 6 6OC <br /> 1VIPCA License No. _ "� `3 <br /> ,- <br /> Staff Review: Approval Denial <br /> Reviewer: 4j,®� �/ Date: Y'( <br /> Reason for Denial: <br />