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. . <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> �� 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> �c/ 2. I will be installing the following: <br /> A. Tanks: �_Precast Concrete Other Manufacturer <br /> TankCapacities: 1) 15�'J gal. 2) 1J� gal 3) r.5�'J 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 other. <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 /> Manifold 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 permit, <br /> a�rees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota,and certifies that all statements made on this application are complete,true and correct. <br /> � <br /> Signature of Applicant L.�'�"'� Date: ���`� �r <br /> MPCA License No. � f-`�/�� <br /> ---------------------------------------------------f--------------------------------------------------------------------- <br /> , <br /> � <br /> Staff Review: Approval � Denial <br /> Reviewer: W� Date• � '� �` � S <br /> Reason for Denial: <br />