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NOTE: Applicant rriust initial all spaces. Fill in all appropriate bla <br /> boxes. nks, check all appropriate <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 1nstalling the+following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) /0-0 19 gal. 2) ,D Ay gal. 3),/ gal;' <br /> B. Pump Station (if required) <br /> Pump make & model r.-' 'v (attach�pump curve & <br /> literature); system design requires i� gpm cu <br /> at / S feet cu head. <br /> High water alarm make & model Outside <br /> • ' electrical work to be completed by installer electrician <br /> other Inside electrical wo <br /> electrician. rk must be completed by <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe Rock bed dimensions 14> <br /> Drop Boxes Sand bed dimensions y rx -7,7 ' - <br /> Distribution Box Pressure Dist..Pipe Diam. <br /> Maniford Pipe Diam. _" <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 ofApplicant <br /> orrect:SignatureofApplicantDate: <br /> MPCA Certification No.: �J - <br /> Staff Review: Appr v >C- Denial <br /> Reviewer: Q r <br /> Date: <br /> Reason for Denial: <br />