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. � <br /> NOT'E: Applicant must irutial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> " 1. I have received a copy of the system design includin� the City of Orono <br /> Septic System Approval Cover Sheet. <br /> � i � ' ' 2. I will be installinQ 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 �_ r� ' ' � (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. t��` Mound <br /> Depth of rock below pipe " Rock bed dimensions �� 'x S� ' <br /> Drop Boxes Sand bed dimensions �y 'x ��°i ' <br /> Distribution Box Pressure Dist. Pipe Diam. j �'� <br /> �� <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, a�rees to do all work in strict accordance with the ordinances of the City and the <br /> reaulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. � <br /> ;, - <br /> SignatureofApplicant: �� = <br /> � � � Date: ��� i,;- �, � <br /> MPCA Certification No.: � �' z� <br /> Staff Review: Approv Denial <br /> - i - f � ) ; <br /> � ' � / <br /> Reviewer: i' Date: �'_- ,, <br /> Reason for Denial: <br />