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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: A Precast Concrete _ Other Manufacturer <br /> Tank Capacities: 1) gal. 2) /� gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model / m�,r•�z A-lo (attach pump curve & <br /> literature); system design requires _�3, gpm at feet of head. <br /> High water alarm make & model Outside <br /> electrical work to be completed by installer/ electrician --A— <br /> other <br /> lectrician --A _other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions _ e ,x W ' <br /> Drop Boxes Sand bed dimensions _A x 7 3 <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> Maniford 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 <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, anA certifies that all statements made on this application <br /> are complete, true and correct. <br /> reofA licant: i:�: Date: <br /> Signature pp �✓J <br /> Xf <br /> g <br /> MPCA Certification Nol <br /> Staff Review: Appr enial <br /> v <br /> Reviewer: Date: /'�✓� <br /> Reason for Denial: <br />