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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet, <br /> 2. 1 will be installin the following: <br /> A. Tanks: ✓ Precast Concrete Other ManufacturerE)4yw " <br /> Tank Capacities: 1)j?c)y gal. 2)_y 364L:) gal 3)13on _gal <br /> B. Pump Station (if required , n L Po <br /> Pump make& model (,f , yt t (attach pump curve& <br /> literature); system design requires �?'l gpm at /y feet of head. <br /> High water alarm make&model L-e Ie— — . 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 it Rock bed dimensions /0 ' x 6 ' <br /> Drop Boxes Sand bed dimensions e ' x <br /> Distribution Box Pressure Dist. Pipe Diam. iz " <br /> Manifold Pipe Diam. y " <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 ofa 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 made on this application are complete,true and correct. <br /> Signature of Applicant CS Date: <br /> MPCA License No. <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval (� Denial <br /> Reviewer: 1 \a?C7C g �� — Date:—5—— —O 3. <br /> Reason for Denial: <br />