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� <br /> t <br /> NOT'E: �Applicant niust initial all spaces. Fill in ali appropriate blanks, check all appropriate <br /> boxes. . <br /> v � ' 1. I have rec ' ' <br /> eived a copy of the system desi?n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> � "�' ' .2. I �vill be installinQ the follow' Q• <br /> in�. <br /> A. Tanks: �recast Concrete Other Manufacturer <br /> Tank Capacities: 1) �al. 2) ?aI. ^) <br /> J � Q�1�, <br /> B• Pump Station (if required) <br /> Pump make & modelZo�fP�� /�y (attach pump curve & <br /> literature); system desi�n requires gpm at feec of head. <br /> Hi�h water alarm make & model tside <br /> • ' elzctrical work to be completed by installer eleccricia <br /> other . Inside electrical work st be completed by <br /> , electrician. <br /> � C. TreaGment System: � <br /> Trenches: s.f. � Mound CX����°h G' <br /> Depth of rock below pipe " Rock bed dimensions 6 'x�' <br /> � Drop Boxes Sand bed dimensions 'x ' - <br /> Distribution Box � Pressure Dist. Pipe Diam. Z � " <br /> Ivlaniford Pipe Dia.m. Z " <br /> D. Final Cover/Topsoil to be: borrowed from sice <br /> (show location on site plan)- � <br /> �trucked in <br /> The undersi�ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, a�rees to do all work in strict accordance wich the ordinances of the City and the <br /> regulations of the State of Minnesota, and cercifies chat all statements made on this application <br /> aze complete, true and correc[: <br /> Si�natureofAppIican[: -�•----- Date:�— �� �1'� <br /> MPCA Certification No.:�y'�f - � <br /> Staff Reriew: Appro Denial � <br /> Revietiver: � • .,l�`p,Q, . . <br /> Date._ u T�;/ <br /> Reason for Denial: <br />