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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 instal in� the followin�: <br /> A. Tanks: � Precast Concrete _ Other Manufacturer p;� R tn_,�:�, <br /> Tank Capacities: 1) I p �'Cgal. 2) �gal. 3) �gal. <br /> B. Pump Station (if required) � <br /> Pump make & model ������k= /��' L `� (attach pump curve & <br /> literature); system desi�n requires gpm at feet of head. <br /> Hi�h water alarm make & model ,�-������ �__Ir�, !- � . Outside <br /> � ' electrical work to be completed by installer electrician <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensions �� 'x �O' .� l <br /> Drop Boxes Sand bed dimensions �'x� <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 Ciry 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, and certifies that all statements made on this application <br /> are complete, true and correct. ,� <br /> SignatureofApplicant: ���� �/�_ -- Date: <br /> � MPCA Certification No.: � � �,� <br /> Staff Review: Appr va Denial <br /> li'� ��✓ � <br /> Reviewer: Date: <br /> Reason for Denial: <br />