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w <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all apprbpriate�• <br /> boxes./ <br /> y 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: I)lggal <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 completed by installer electrician other. <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 ' <br /> Distribution Box Pressure Dist. Pipe Diam. It <br /> Manifold Pipe Diam. " <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 Minnesota,and certifies 1 statements made on this application are complete,true and correct. <br /> Signature ofApplicant Date: 3o L' <br /> MPCA License No. <br /> -t <br /> Staff Review: Approval Denial <br /> Reviewer: Q '^ NDate: <br /> Reason for Denial: <br />