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NOTE: �Applicanc rriust irutial all spaces. FilI in all appropriate bIanks,� check all a ro riate <br /> boxes. . pp p <br /> / �� 1. I have received a co ' <br /> py of the system desi;n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. - <br /> . � <br /> � �J 2. I �viIl b Q � � . . <br /> e installin� thz fo11owinQ:'� - . <br /> A. Tanks: ��precast Concrete Ocher 1VSanufacturer���w� � <br /> Tank Capacities: 1) ���G� gaI. 2)jC�z;' Qal. ^ , <br /> � ,) ��a�i, . <br /> � - B• Pump Station (if required) <br /> Pump make & model ��c��/�Q l,��05"'// (attach pump curve & <br /> literature); system desi�n requires � � opm ac 1� feet of head. <br /> Hi�h tvater aiarm make & model � j�,�,,,,� <br /> • ' electricaI work to be completed by�`��ller • Outside <br /> other eleccrician <br /> . Inside electrical work must be completed by <br /> electrician. <br /> � C. Treatment System: � �� <br /> � Trenches: s.f. �/ IVlound <br /> Depth of rock below pipe " Rock bed dimen.sions �Q �'x�-� ' <br /> Drop Boxes � Sand bed dimensions L'x�° - <br /> Distribucion Box Pressure Dist. Pipe Diam. i '�z " <br /> .Maniford Pipe Diam. Z: " <br /> D. Final Cover/Topsoil to be: �onoived from site <br /> (show location on sice pIan)- � <br /> irucked in <br /> The undersi�ned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, agrees to do aIl work in s[rict accordance wi[h the ordinances of the City and the <br /> reguIations of the State of iVlinnesota, and certifies Lhat all sEatements made on this appIication <br /> are complete, true and correct: <br /> ._---��T�-I� - <br /> < � / , _ <br /> Si�natureofApplican[: j�-��-° Date. 7 '��, � ��' <br /> MPCA Cer[ifcation No.: � �f � � . - � <br /> Staff Reviesv: Approval � Denial . . � <br /> � ReFietiver: � • . � <br /> � / Date: T - Z�- ��i <br /> Reason for Denial: ' � � <br />