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- „ s <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> v 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 ��c���� <br /> Tank Capacities: 1) �� gal. 2) �'DD�gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires 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: G68 s,f. Mound <br /> Depth of rock below pipe /a " Rock bed dimensions 'x ' <br /> _� Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> „ <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borrvwed from site <br /> �x�s�„�,,, (show location on site plan) <br /> -�-- trucked in <br /> �'i�e 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 correct. <br /> SignatureofApplicant: Date: s=ZJ—y�_ <br /> MPCA Certi�cation No.: Sy� <br /> Staff Review: Approv Denial <br /> Reviewer: Date: �a �` <br /> Reason for Denial: . <br />