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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxes. <br />y I. I have received a copy of the system design including the City of Orono <br />Septic System Approval Cove* Sheet. <br />2. I will be installing the following: <br />A. Tanks: Precast Concrete _ Other Manufacturer <br />Tank Capacities: 1) /%iG gai. 2) X:,,: gal. 3) i o gal. <br />B. Pump Station (if required) <br />Pump make & model L-2 /. (-, « pct_ (attach pump curve & <br />literature); system design requires_ pm 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: <br />Trenches: <br />Depth of rock below pi <br />Drop Boxes <br />Distribution Box <br />s. f. Mound <br />pe Rock bed dimensions /6 'x <br />Sand bed dimensions <br />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.�j' <br />SignatureofApplicant: C Date:�A' <br />MPCA Certification No.: <br />Staff Review: Approval '�< Denial <br />A�5Reviewer: a/ <br />Date: f <br />Reason for Denial: <br />