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� � , <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> �' , <br /> �� �1. I have received a co of the s stem desi n includin the Ci <br /> _ py y g g ty of Orono Septic <br /> - System Approval Cover Sheet. <br /> � 2. I will be install�in the following: <br /> A. Tanks: / Precast Concrete Other Manufacturer�'4'""'�"� <br /> Tank Capacities: 1)� 3�C., gal. 2) ���:, gal 3) /3�� 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 cornpleted by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. �/ Mound <br /> Depth of rock below pipe " Rock bed dimensions 1�' x 6�'' <br /> Drop Boxes Sand bed dimensions��' x�' <br /> Distribution Box Pressure Dist. Pipe Diam. �iY ' `' " <br /> Man' old Pipe Diam. z " <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 /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature ofApplicant Date: � ' -���—�� 3 <br /> MPCA License No. b`t� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Revie�v: Approval � Denial <br /> Reviewer: �C� �' ���� Date• � �� d 1L� <br /> Reason for Denial: <br />