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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: Oqn' <br /> A. Tanks: �_ Precast Concrete _ Other Manufacturer yt <br /> Tank Capacities: 1) L3� gal. 2) 13�v gal. 3) / gal. <br /> B. Pump Station (if required) <br /> NIG S2� (attach pump curve & <br /> Pump make & model <br /> literature); system design requires �s -1_ gap at 3 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 ' <br /> Rock bed dimensions �Q'x <br /> Drop Boxes Sand bed dimensions F? 'x_LQZ X yU <br /> Distribution Box Pressure Dist. Pipe Diam. P/7- <br /> Maniford Pipe Diam. Z of <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 /> Signature of App licant: <br /> 121-� Date: <br /> MPCA Certification No.: <br /> Staff Review: Approv Denial <br /> —C;�—% <br /> Reviewer: - <br /> Date: O <br /> Reason for Denial: <br />