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- "0 <br />NOTE: Applicant most initial all spaces.. Fill in all appropriate blanks, check all -pp upcia <br />boxes. <br />rr <br />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 Manufacum <br />Tank Capacities: ,I) gal. 2) gal. • 3) gal. <br />1 ". <br />B. Pump Station (if required) <br />Pump make & model __/[ : • i " (attach pump curve & <br />literature); system design negn Tres 3 ; gpm at feet of bead. <br />High water alarm make & model t - 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. <br />Depth of rock below pipe so <br />Drop Boxes <br />Distribution Box <br />Mound <br />Rock bed dimensions i o 'x hL' <br />Sand bed dimensions ,. - 'x y a <br />Pressure Dist. Pipe Dam. _ w <br />Maniford Pipe Dram. z <br />D. Final Cover/Topsod 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 syteeem 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 compiese, true and correct. <br />SignatmofApplicant: Date: <br />AMA Certification X ") `/ <br />Staff Review: Appnwai _ Dodd <br />Dam C: <br />0� lbr Deddt <br />