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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:�- Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) � gal. 2) �� gal. 3) �''-'� gal. <br /> B. Pump Station (if required) „ . _ <br /> Pump make & model /� J��_ �.� !" (attach pump curve & <br /> literature); system design requ�res � gpm at feet of head. <br /> High water alarm make & model 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. � Mound <br /> Depth of rock below pipe " Rock bed dimensions��_'�G ' <br /> Drop Boxes Sand bed dimensions��'x��' <br /> Distribution Box Pressure Dist. Pipe Diam. /�" <br /> Maniford Pipe Diam. ��2_" <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> _-�'={`uhow location on site plan) <br /> cked 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, and certifies that all statements made on this application <br /> are complete, true and corre . ; <br /> ,� / �� <br /> SignatureofApplican �����cr/4�1� ���--�._ Date: .� �,��( - �� <br /> _ _ __l .� <br /> MPCA Certification No.: � <br /> Staff Review: Approval / Denial <br /> Reviewer: � � Date• �'�`���� <br /> Reason for Denial: . <br />