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H <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 design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: -C Precast Concrete _ Other Manufacturer <br /> Tank Capacities: 1) 3 W gal. 2) c�) gal. 3) / ?uD gal. <br /> B. Pump Station (if required <br /> k / <br /> Pump make & model - /-1 y (attach pump curve & <br /> literature); system design requires _ gpm at Z 3 feet of head. <br /> High water alarm make & model Outside <br /> • ' electrical work to be completed by installer electrician_X <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: 2- <br /> Trenches: s.f. Mound /a <br /> Depth of rock below pipe " Rock bed dimensions AL'x G� 'z/2 <br /> Drop Boxes Sand bed dimensions 'x ' Zo <br /> Distribution Box Pressure Dist. Pipe Diam. /",L" 3 <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 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 v D ni <br /> Reviewer: - <br /> �' Date: <br /> Reason for Denial: <br />