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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 <br />Tank Capacities: 1) gal. 2)1 r , gal. 3) /� gal. <br />B. Pump Station (if required) We osil . <br />Pump make & model % �6o /Y (attach pump curve & <br />literature); system design requires 3?'_ gpm at H feet of head. <br />High water alarm make & model L-- e / 4 R m Ou de <br />electrical work to be completed by installer - electricians <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 /e7 'x Sb' <br />Drop Boxes Sand bed dimensions fz- 'x_2;2-' <br />Distribution Box Pressure Dist. Pipe Diem. <br />Maniford 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 <br />permit, agrees to do all work in strict accordance with the ordinances of the City and the <br />regulations ui the State of Minnesota, and certifies that all statements made on this application <br />are complete, true and correct. <br />SignatureofApplicant: Date: to <br />MPCA Certification No.: T i Z <br />Staff Review: Approvpl v Denial <br />Reviewer: Date: <br />Reason for Denial: <br />