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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 syste;n design including the City of Orono <br />Septic System Approval Cover Sheet. <br />2. I will be mstalI)nS the following: <br />A. Tanks: �/ Precast Concrete _Other Manufacturer ��:.� <br />Tank Capacities: 1) gal. 2) gal. 3) gal. <br />B. Pump Station (if required) <br />pump make & model (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 by <br />electrician. <br />C. Treatment System: <br />Trenches: s.f 10- .13 Mound <br />Depth of rock below pipe Rock bed dimensions L'x XT' <br />Drop Boxes Sand bed dimensions '�L'x__' <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 />tricked in <br />The undersigned hereby applies to the City of septic system installation <br />permit, agrees to do all work in strict accordiftCe with the ordinances of the City and t' <br />regulations of the State of Minnesota, and certifies that all statements made on this applicati. <br />are complete, true and correct. <br />Signatureof Applicant: <br />MPCA Certification No.: <br />Staf Review: Approval <br />Reviewer: <br />Reason for Denial: <br />f <br />Denial <br />�j <br />Date: 8' <br />