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t + <br /> NOTE: 'Applican[ rriust initial all spaces. Fill in alI appropriate blanks, check all appropriate <br /> boxes. - <br /> ;- = <br /> , . <br /> 1. I have received a copy of the system desi�n including the Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> �. j� : � .2. I wiIl be�instaIlin� thz followinQ; . - � � <br /> A. Tanks: �precast Concrete Ocher Manufacturer <br /> Tank Capacities: I)� QaI. 2) C.�j oal. ��y�f� <br /> � �_ � 3) f'�'�r oaL <br /> � - B• Pump Station (if required) � ����� <br /> Pump make & model ly�U. S �� �/z , <br /> Iiterature); system desi�n rzquires � '`� (attach pump curve & <br /> High tvater aIarm make & model oPm at feet of head. <br /> • ' eiectrical work to be completed by installer • Outside <br /> other eleccrician <br /> . Inside electricaI work mcist be completed by <br /> electrician. . <br /> ' C. Treatment System: / <br /> � Trenches: s.f. !/ Mound <br /> Depch of rock below pipe " Rock bed di.mensions/(� �'X�..� ° <br /> Drop Boxes Sand bed dimensions�'x�� - <br /> Distribution Box Pressure Dist. Pipe Diam. i'%' <br /> � .Maniford Pipe Diam, z� " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> �,Show location on sice pla�)- � <br /> ��trucked in <br /> The undersi;ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do aIl work in s[rict accordance �vich the ordinances of the City and the <br /> . reguIations of the State of Minnesota, and certifies thac all statements made on this application <br /> are complete, true and correct: <br /> _-------� . <br /> -�__ <br /> Si�natureofApplicant: Date: 8�'Z� - � � <br /> MPCA Certification No.:_��� . - � <br /> Staff Reviezv: Ap�or vai Denial . . � <br /> ' �,' ' . <br /> � ReFiesver: � �% �f���r' ' - . . <br /> . -�—i Date:_ �__��•�`1 <br /> . �— <br /> Reason for Denial: <br />