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NOTE: �Applican[ rriust initial all spaces. Fill in aIl appropriate blanks, check all appropriate <br /> boxes. . <br /> '�/ 1. I have received a copy of the system desi�n includinQ <br /> Septic System Approval Cover Sheet. � �e Clty of Orono <br /> . r./ � .2. I �viIl be�installin� the followin?: � � <br /> A. Tanks: -✓�recast Concrete Other �,,,., ,�„� <br /> Tank Ca acities: 1 j Manufacturer.�� <br /> P ) d�o �al. 2) �,� jal. 3) '� 3�o QaI.` <br /> a , <br /> B• Pump Station (if required) <br /> Pump make & model w�v3�� ��3 � � • (attach pump curve & <br /> literature); system desi�n requires —3� opm at / �/ feet of head. <br /> , Hi�h water alarm make & model _��� l��-,.,,` Outside <br /> • electrical work to be completed by uistaller ✓ eleccrician <br /> ocher . Inside electrical work must be compleced by <br /> eleccrician. <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 7v ' - <br /> Distribution Box Pressure Dist. Pipe Diam. � '� " <br /> Maniford Pipe Diam. Z.` " <br /> D. Final Cover/Topsoil to be: borroived from site <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 /> pecmit, agrees to do aIl work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies [hat all statemencs made on this application <br /> are complete, true and correct: <br /> �.� <br /> Si�natureofApplicant: Date:_ �' — L� '� s <br /> MPCA Certification No.:_��C) - � <br /> Staff Reriesv: Ap�oval � ` / Denial . � <br /> �r, <br /> � . <br /> ; <br /> Reviesver: ( i;-��,,,, r �";� ���i � � • . . <br /> - Date: � - - ,,�� - �� <br /> � <br /> Reason for Denial: <br />