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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. A <br /> N 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: 1) gal. 2) gal 3) gal <br /> B. Pump Station (if required) <br /> Pump make :• odel ."tach pump curve& <br /> literature); syste • design requires gp • feet of head. <br /> High water alarm ma. = : model . Outside <br /> electrical work to be comple - : • ins . er electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. Mo <br /> Depth of rock below pipe " Rock bed dimension ' x <br /> Drop Boxes Sand bed dimensions <br /> Distribution Bo Pressure Dist. Pipe Diam. <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 that all statements made on this application are complete,true and correct. <br /> Signature of Applicant Date: <br /> MPCA License No. <br /> Staff Review: Approval Denial <br /> Reviewer: Date: / - 3- <br /> Reason <br /> Reason for Denial: <br />