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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 desiJgn including <br /> the City of Orono <br /> Septic System Approval Cover Sheet. <br /> .2. I will be install' the following- <br /> L- <br /> A. <br /> ollowing:A. Tanks: _Precast Concrete Other ManufacturerA- <br /> - <br /> Tank Capacities: 1) gaI. 2) - � gal. 3) gal, <br /> B. Pump Station (if required) <br /> Pump make & model .,� J�Q (attach pump curve & <br /> literature); system design requires _ gpm at a.;7,ur{eet of head. <br /> High water alarm make & model 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. L"Mound <br /> Depth of rock below pipe Rock bed dimensions <br /> Drop Boxes Sand bed dimensions 'x <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Maniford Pipe Diam. 1 " <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 /> SignatureofApplicant: Date: <br /> MPCA Certification No.: <br /> Staff Review: Appro al Deni <br /> Reviewer: Date: '�� <br /> Reason for Denial: <br />