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� <br /> NOTE: Applicant must initi 1 all spaces. Fill in all appropriat blanks,, check all appropriate <br /> boxes. ..� �yj�2C-� �•(� �z <br /> U� �l , t� a �, ,��- <br /> � <br /> 1. I have received a copy of the system desijn including the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin� the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make & model 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 '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: borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersi�ned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, a�rees 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 /> n <br /> SignatureofApplicant: - � Date: //—� � � �f' � <br /> MPCA Certification No.: <br /> Staff Review: Approval � Denial <br /> Revie�ver: - Date: �a�' <br /> Reason for Denial: <br />