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NO'TE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropnate <br /> boxes. <br /> � '`�%� 1. I have received a copy of the system design including the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> , � <br /> � �;��� 2. I will be installin� the following: <br /> A. Tanks: � � Precast Concrete _ Other Nlanufacturer <br /> Tank Capacities: 1) i 5���� �al• 2) i_„_�, �al. 3) r_-,�r, �al. <br /> B. Pump Station (if required) �µ,P,� <br /> Pump make & model��lc1�t.r►lro ►oi2.�-�- (attach pump curve & <br /> literature); system design requires �_ gpm at ��_ feet of head. <br /> Hi�h 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: ,— I� <br /> Trenches: s.f. �-_'` � Mound <br /> Depth of rock below pipe ock bed dimensions 1 c 'x C � ' <br /> Drop Boxes Sand bed dimensions �3� '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 site plan) <br /> �'���� trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> re�ulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and co_rrect. <br /> _ � � ��� .� —� Date: ��= ` � � �` <br /> SignaturcofArrlicant: ' <br /> MPCA Certification No.: '� <br /> 'I `_� <br /> Staff Review: Appr val Denial <br /> Reviewer: <br /> Date• �f����� <br /> Reason for Denial• <br />