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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: <br /> A. Tanks: > Precast Concrete _ Other Manufacturer <br /> Tank Capacities: 1) %cxc gal. 2) / i(.,' gal. 3) /c gal. <br /> B. Pump Station (if required) <br /> Pump make & model 6,-i' 1.0E6 57/ (attach pump curve & <br /> literature); system design requires gpm at 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: ,0 <br /> Trenches: s.f. j* Mound <br /> Depth of rock below pipe " Rock bed dimensions /p 'x ' <br /> Drop Boxes Sand bed dimensions 9jo 'x r7 ' <br /> Distribution Box Pressure Dist. Pipe Diam. /5 " <br /> Maniford Pipe Diam. z " <br /> D. Final Cover/Topsoil to be: .111-- 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 Applicant: %/� Date: 6^//e-/ <br /> MPCA Certification No.: <br /> Staff Review: Approv> Denial <br /> Reviewer: <br /> / /.�.�; Date: <br /> / . �/ � Q - <br /> Reason for Denial: <br />