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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: �►'CC�cS� <br /> A. Tanks: �Precast Concrete _ Other Manufacturer <br /> Tank Capacities: 1) l 3c-o gal. 2) l?,,o gal. 3) 1 ?c/o gal. <br /> B. Pump Station (if required) (attach pump curve & Le <br /> Pump make & model/11G /D <br /> SS <br /> literature); system design requires _39 gpm at feet of head. <br /> High water alarm make & model 1,o odo- 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 L(L�x � <br /> Drop Boxes Sand bed dimensions � x_ 2- <br /> Distribution Box Pressure Dist. Pipe Diam. (%L " <br /> Maniford Pipe Diam. -2- <br /> D. <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 /> (�; �^ <br /> SignatureofApplicant: f --�� O Date: <br /> MPCA Certification No.: <br /> Staff Review: Appr val Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />