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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 inst lling the following: 1 <br />A. Tanks: )- Precast Concrete 10 "Other Manufacture► <br />Tank Capacities: 1) IL,5-Cl gal. 2) gal. 3) gal. <br />B. Pump Station (if required) <br />Pump make & model A4 E J-0 (attach yump curve & <br />literature); system design requires � opm at � feet of head. <br />High water alarm make & model LV 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. Mound <br />Depth of rock below pipe Rock bed dimensions L'xZ' <br />Drop Boxes Sand bed dimensions 3? 'x 8' 3 ' <br />Distribution Box Pressure Dist. Pipe Diam." <br />Maniford Pipe Diam. <br />D. Final Cover/Topsoil to be: �orrowed from site <br />(show locatio:i 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 ordinanzes 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: �.>� L1-1 2-/- 1, uzx -/— Dater <br />MPCA Certification No.: 17 <br />Staff Review: Apprgval %` Denial <br />Reviewer: v - �" Date: <br />Reason for Denial: <br />