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. <br /> NOTE: 'Applicant rriust uutial alI spaces. Fill in alI appropriate blanks,� check all appropriate <br /> boxes. . <br /> _--� �� . : <br /> I. I have received a copy of the system desi�n includin� the Ciry of Orono <br /> Septic System Approval Cover Shee[. - <br /> . ` . <br /> � � . �� .2. I �vill be�installin� thz followinQ: : _ � <br /> A. Tanks: ✓ptecast Concrete Other ���: � <br /> Tank Capacities: 1) oU gai. 2 . , � , Q Manufacture� <br /> �� <br /> � �31. � ��o'�Ir <br /> � - B• Pump Station (if required) <br /> Pump make & model �J�0 3�/ ����� (�ttach pump curve & <br /> literature); system desi�n requires _ �7 opm at _ %� feet of head. <br /> . Hi�h wacer alarm make & model t��� � ,� • Outside <br /> • electricaI tivork 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. �/ Maund <br /> Depth of rock below pipe " Rock bed dimensions l� 'x 6� ' <br /> Drop Boxes � Sand bed dimensions ��'x�' - <br /> Distributian Box Pressure ��sr, pipe Diam. i �iZ " <br /> � � .Maniford Pipe Diam. � ° <br /> D. Final Cover/Topsoil to be: `� borrowed from site <br /> (show location on site pIan}- <br /> trucked in <br /> The undersi�ned 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 of the State of Minnesota, and cenifes that all statements made on this application <br /> are complete, irue and correc[: <br /> � <br /> Si�na[ureofApplicant: �„� __ �' c� <br /> . . Date: ��� � Z- � � � <br /> MPCA Certifcation No.: � - - • <br /> Staff Reriew: Ap �aI Denial . . � <br /> � ReFiesver: . i� . � . , � <br /> . Date:_ l� - �� - `�-� <br /> Reason for Denial• � <br />