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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 Cape�1) gal. 2) /4k"� gal. 3)/ gal. <br />Gr� Z ox� <br />B. Pump Station (if requiret� PS, <br />Pump make &model _s i # / NP (attach pump curve & , �f <br />literature); system design requires gpm at / feet of mead. <br />High water alarm make & model Outside <br />electrical work to be L ipleted by __ installer electrician x, <br />r _ Inside electrical work must be completed by <br />rician. <br />-vent System: <br />_ _ Trenches: s.f. Mound <br />Depth of rock below pipe Rock bed dimensions 'x a 7' <br />Drop Boxes Sand bed dimensions .9S 'x /s' <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 />_K 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 correc• <br />Signature ofAppl icant: Date: _� -is - FG <br />MPCA Certifica,.:n No.: S� <br />Staff Review: Appro, al Denial <br />Reviewer: Date: �( _ <br />Reason for Denial: <br />