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" a <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: _?e Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 1,3�o gaI. 2) lavv dal. 3) ��oD gal. <br /> `Z <br /> a <br /> B. Pump Station (if required) <br /> Pump make & model (attachump curve & <br /> literature); system design requires Q gpm at feet of head. <br /> Hiah water alarm make & model GuPv 3!t !t2 h.n� (�. Outside <br /> electrical work to be completed by installer', electricianK <br /> other Inside electrical work must be completed by_ <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Moudd <br /> Depth of rock below pipe Rock bed dimensions le 'x Ss' <br /> Drop Boxes Sand bed d' erasions �'x sS`- <br /> Distribution Box Pressure Dist. Pipe Diam. 1 " <br /> Maniford Pipe Diam. 2:,_ " <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 co t. <br /> SignatureofApplicant: Date: .S / <br /> MPCA Certification No.:. re <br /> Staff Review: Appr val Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />