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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 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.L- cc". '^ <br /> Tank Capacities: 1) /ow gal. 2) l cc , gal. 3) (coo gal. <br /> B. Pump Station (if required) <br /> Pump make & modeles (Q . i,L,C.o 3/f (attach pump curve & <br /> literature); system design requires 3d gpm at i 2- feet of head. <br /> High water alarm make & model L��_l,� �. . Outside <br /> electrical work to be completed by installer i— 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 /o 'x y/ ' <br /> Drop Boxes Sand bed dimensions Y3 'X 7 s' <br /> Distribution Box Pressure Dist. Pipe Diam. / 't'z <br /> Maniford Pipe Diam. 2_ " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> rucked 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: _ Date: <br /> MPCA Certification No.: Coa <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> 7/,,,7j/9r <br /> Reason for Denial: <br />