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NOTE: 'Applicant must initial all spaces. Fill in all appropriate blanks, check all a ro riate <br /> boxes. pp p <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'iastalling the following:' <br /> A. Tanks: cast Concrete Other <br /> Tank Capacities: 1) gal• 2 f a Manufacturer <br /> �_. Jal. ,)2etE�L dal: <br /> B. Pump Station (if required) <br /> Pump make & model 1,y�E7C3 5-/ ?-� (attach pump curve & <br /> literature); system design requiresapm at 13 �- feet of head. <br /> High water alarm make & model _ <br /> • ' electrical work to be completed by installer Outside <br /> other ✓Tctrician <br /> 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 /U -'x y/. <br /> Drop Boxes Sand bed dimensions <br /> Distribution Box � 7s' <br /> Pressure Dist. Pipe Diam. <br /> Maniford Pipe Diam. v " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> _,-Wow location on site plan)- <br /> y <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 <br /> SignatureofAppIicant: Date: <br /> MPCA Certification No.: - <br /> Staff Review: App o al Denial <br /> ReFietiver: Date: <br /> Reason for Denial: <br />