1992-004426 - replace septic - Laserfiche WebLink

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r SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 Permit Type & Fees (check one) New Construction, Full System $100. 00 Repair or Replace Existing System $50. 00 $0.50 State surcharge added to above permit fees SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES DO NOT MAIL PAYMENT WITH THIS APPLICATION *************************************************************************** NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate boxes. Initial ✓ 1. I have received a copy of the system design including the City of Orono Septic System Approval Cover Sheet. 2 . I will be installing the following: A. Tanks: ✓ Precast Concrete Other Manufacturer 4 / i Tank Capacities: 1) gal. 2 ) gal. 3 ) /e'e',Ogal. yrs PYal B. Pump Station (if required) h Pump make & model 21-( (attach pump curve & & rh rled by literature) ; system design requires ''o gpm at feet of head. High water alarm make & model 2 ' L" gQ 'rbl/G' Outside electrical work to be completed by installer I electrician v'other . Inside electrical work 11? BI^ must be completed by electrician. C. Treatment System: Trenches: s.f. L- Mound Depth of rock below pipe Rock bed dimensions /O 'x Drop Boxes Sand bed dimensions 3r'x 77' Distribution Box Pressure Dist. Pipe Diam. Z " Manifold Pipe Diam. r YZ " D. Final Cover/Topsoil to be: +- borrowed from site (show location on site plan) trucked in *************************************************************************** The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. Signature of Applicant: S, Zi/ �'u- &--5-- Date: MPCA Certification No. : b 7/