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. . <br /> NOTE: Applicant must initial all spaces. Fill in all apgropriate blanks, check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system desi�n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installinQ e followin�: <br /> A. Tanks: Precast Concrete Other Manufacturer[�c�LL S <br /> Tank Capacities: 1) �.>� �al. 2) d �5� gal. 3) gal. <br /> B. Fump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system desi�n rzquires gpm at feet of head. <br /> Hi�h water alarm make & model Outside <br /> • ' electrical work to be completed by installer electrician <br /> o�her Inside eiectncal work must be completed by <br /> eleccrician. <br /> � �r <br /> C. Treatment System: `f�� � %��r�� ��� �J �,-,��urT./!�sS -`�� <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions 'x ' <br /> � Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: v'�borro�ved from site <br /> (show location on site plan) <br /> trucked in <br /> The undersijned hereby appIies 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 certifies that all statements made on this application <br /> are complete, true and correct. <br /> Si�natureofApplicant: � -� ��_�� Date• <br /> � �v <br /> MPCA Certification No.:_ � �� <br /> Staff Review: App yal Denial <br /> . � s . <br /> Revietiver: �j �,�� Date: `/�z5�-��% <br /> Reason for Denial: <br />