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4 <br /> , 4 <br /> SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Constructi. . _ stem $100. 00 <br /> 1,---Repair or 'eplace Existin. System $50.00 <br /> $0. 50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> *************************************************************************** <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> nitial <br /> 6)72 2 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: D, Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) / (M gal. 2 ) 104 gal. 3 ) gal. <br /> B. Pump Station (if required) <br /> boshCA113 Pump make & model 1'kaDon•,t-c.-J ,k i✓, (attach pump curve & <br /> rr� _� literature) ; system design requires L/ 0 gpm at /S feet <br /> 4 +P 30 p4 of head. High water alarm make & model -/---GPr--, <br /> Outside electrical work to be completed by installer <br /> head- 1a{rr _electrician _other . Inside electrical work <br /> p �y must be completed by electrician. <br /> �wMf�re� ' C. Treatment System: <br /> � Trenches: s.f. (- Mound <br /> Depth of rock below pipe II Rock bed dimensions /0 'x5-51 <br /> Drop Boxes Sand bed dimensionsXx 3t-1 <br /> Distribution Box Pressure Dist. Pipe Diam. 171- " <br /> /Manifold Pipe Diam. A `/ " <br /> D. Final Cover/Topsoil to be: V borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> *************************************************************************** <br /> The undersigned hereby applies to the City of Orono for issuance of a <br /> septic system installation permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> Signature of Appli cat: Date: /h J./L7 <br /> MPCA Certification No. : 76, c <br />