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SEPTIC SYSTEM PERMIT APPLICATON -'PAG$ 2 <br />Permit Type & F LLei� (check one) <br />Jjr/New Construction, Full System -$ S' G, <br />Replace Existing System (1 or more new tanks & drainfield) $50.00. . . <br />—Partial Replacement (replace just tanks or just drainfield) $30.00. . . <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 />NOTE: Applicant must initial all spaces. Fill in all appropriate blanks. <br />check all appropriate boxes. <br />Initial <br />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 foAl�ing: <br />A. Tanks: Precast Concrete V Other Manufacturer Cu4L S <br />Tank Capacities: 1) 115o gal. 2) 100o gal. 3) gal. <br />B. Pump Station (if re uired) <br />Pump make & model E r - ��� �'`,6eL ( attach pump curve & <br />literature); system design requires gpm at 26� feet <br />of head. High water alarm make & model do #dy- Sc-,%eAW. r-k- . <br />trical work to be completed by _installer <br />electricia other Inside electrical work <br />mus a completed by electrician. <br />C. Treatment System: <br />Trenches: s.f. Mound <br />Depth of rock below pipe ro Rock bed dimensions 19'x ' <br />Drop Boxes Sand bed dimensions 'x U' <br />Distribution Box Pressure Dist. Pipe Diam.A.5—r <br />Manifold Pipe Diam. /,S " <br />D. Final Cover/Topsoil to he: borrowed from site <br />(show .location on site plan <br />trucked in <br />The undersigned hereby applies to the City of Urono for issuanc4 of a <br />septic system installation permit, agrees to do all work in strict <br />accordance witr the ordinances of the City and the regulations of the State <br />of Minnesota, d certifies that all statements made on this application <br />are complete, true and correct. <br />Signature of Applicant: Date: <br />MPCA Certification No.: <br />