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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />Permit Type i Fees (check one) <br />x <br />New Construction, Full System $100.00 . . . . . . . . . . . . • • <br />Repair or Replace Existing System $50.00. . . . . . . . . . • . • <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 />•:::*:****eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee*ee*::*ee*eee:::*:**:*eee** <br />MOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />initial <br />no 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 following: <br />A. Tanks: x Precast Concrete other Manufacturer <br />Tank Capacities: 1 100d gal. 2 1250 gal. 3)12,1.9.._gal. <br />B. Pump Station (if required) <br />Pump make 6 model blue angle 40 (attach pump curve i <br />literature); system design requires 57.7gpm at 18.5 _ feet <br />of head. High water alarm make i model • <br />Outside electrical work to be complete y installer <br />_electrician _X_other Inside electrical work <br />must be completed by electrician. <br />C. Treatment System: <br />Trenches: s.f. <br />Depth of rock =e ov pipe <br />Drop Boxes <br />Distribution Box <br />Mound <br />Rock bed dimensions �,' x�' <br />Sand bed dimensions ' x,9, - <br />Pressure Dist. Pipe D am.," <br />Manifold Pipe Diam. _2 <br />D. Final Cover/Topsoil to be: borrow from site <br />(show location on site plan) <br />x trucked in <br />•eeeeeeeeeeeeea*:ee:::ee*eee*�**:::eeee:*eese:see*eeeee**:eeeee*:::eseee*:* <br />The undersigned hereby applies to the City of Orono for issuance of a <br />septic system installation permit, agrees to do all work in strict <br />accordance with the ordinances of the City and the regulations of the State <br />of Minnesota, and certifies that all statements made on this application <br />are complete, true and correct. <br />Signature of Applicant: Dats <br />813 <br />MPCA Certification No.: 0 <br />