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.1 <br /> S <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> /h 2 1. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> Z 2. I will be installing the following: <br /> A. Tanks: Precast Concrete _ Other Manufacturer rxcGg sT <br /> Tank Capacities: 1) 13 n o gal. 2) /od-o gal. 3) 1.30,, gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires 3 gpm at 3O 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. atment System: <br /> Trenches: s.f. Mound <br /> Depth ro elow pipe Rock bed dimensions to 'x G8' <br /> o Boxes Sand bed dimensionsYL <br /> 'x /o <br /> Distrib n Box Pressure Dist. Pipe Diam. <br /> Marniford Pipe Diam. a <br /> D. Final Cover/Topsoil to be: X 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 /> c <br /> Signature ofApplican : Date: / 3 r6 <br /> MPCA Certification No.: <br /> Staff Review: Appr val Denial <br /> Reviewer: ��/ Date: 1Z� <br /> Reason for Denial: <br />