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�- . . � <br /> . . , <br /> 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 desi?n including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin� 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 �� (attach pump curve & <br /> literature); system desi;n requires �/�gpm at �feet of head. <br /> High water alarm make & model ,� Outside <br /> • electrical work to be completed by installer � electrician� <br /> o[her . Inside electrical work musat be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. _� Mound <br /> Depth of rock below pipe " Rock bed dimensions /a 'x 7�� <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 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 Ciry 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 /> G. <br /> SignatureofApplicant• Date: <br /> . <br /> MPCA Certification �/� <br /> Staff Review: Approval __� Denial <br /> Reviewer: Date: 7`��0'' <br /> Reason for Denial: <br />