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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 Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: ���w'��� <br /> A. Tanks: Precast Concrete X Other Manufacturer U�i'�-rJ�� <br /> Tank Capacities: 1) �uC�gal. 2) Ck%� gal. 3) G'Uc.�' 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 �{�'r� ��:�.--_._ ---CLtside <br /> electrical work to be completed by installer electrician �_ <br /> other Inside electrical work must e co eted by <br /> electrician. <br /> C. Treatment System: <br /> _� Trenches: ��G' s.f. Mound <br /> Depth of rock below pipe I C� " Rock bed dimensions 'x ' <br /> �_ Drop Boxes Sg Z 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 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 ordinances of the City and the <br /> rewlations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant: ----�� Date: ,�'l" �"— ��`��`�� <br /> MPCA Certification No.: 1 ��� <br /> Staff Review: val Denial <br /> n Date• 2 — "7-- c� <br /> Reviewer: �� ' �� � <br /> Reason for Denial: <br /> � /1 c.Z-^1J �U G c�1- /P�t.=YZ �-72 vm I-EO rn�'��.�;•�c 1Z c� �� y�a��h (o o Y i vt� ��-u��-12'��f <br /> �� � r[ c��J ���s ����, -� �-o �� �_�55 p�p�-��Y �-� r�s�G r ( >�� S��u-, � <br />