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, ' • <br /> NOT'E: �Applicanc rriust initial all spaces. Fill in all appropriate blanks, check all a rv ria <br /> boxes. - Pp p te � <br /> 1. I have received a copy of the system desi�n includin� the Ciry of Orono <br /> Sep[ic System ApproYal Cover Sheet. . • <br /> �. � .2. .I �viIl be�iri�tallin� the followinQ:'� � . � <br /> � A. Tanks: precast Concrete �Ocher �`�/ 1�Ianufaccurer <br /> Tank Capacities: 1) v jaI. 2 Q <br /> _�� ��,5� �21. j� a�i, . <br /> � - B• Pump Station (if required) �/�� <br /> Pump make & model . � (attach pump curve & <br /> Iiterature); system desi�n rz4uires Q <br /> Hi�h water alarm make & model �Pm at feet of head. <br /> • ' electrical work to be completed by installer • Outside <br /> other electrician <br /> . IrLside eIectrical work must be completed by <br /> electrician. . <br /> ' C. Trea[r�nent System: <br /> � ��� Trenches: � 5,f, Mound <br /> Depch of rock below pipe c, " Rock bed dimensions �'x � <br /> _�Drop Boxes - Sand bed dimensions 'x ° - <br /> Distribution Box � Pressure Dist. Pipe Diam. � " <br /> � .Ivianiford Pipe Diam. ' " <br /> �,����,� ' L�.rS <br /> D. Final Cover/Topsoil to be: c�borrowed from site <br /> (show location on site pla.n)- . <br /> trucked in <br /> The undersi�ned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance ivith the ordinances of the City and the <br /> regulations of the State of Minnesota, and cenifes that all stacemencs made on tb.is application <br /> are complete, true and co,Frect: <br /> � � <br /> � <br /> Si�natureofApplicant: � � �� %�� � = <br /> . . Date:_ '� v J�1/�''1 �7 <br /> . , <br /> MPCA Certif cation No.:�[� . . - � <br /> Staff Review: Approval � Deniai . . � <br /> � ReFieiver: Date: '1- � �5'� � <br /> Reason for Denial: � <br />