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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 desijn including the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin� the followina: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gai. 2) gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system desi�n requires gpm at feet of head. <br /> Hi�h water alarm make & model Outside <br /> � ' electrical work to be completed by installer electrician <br /> �" - other Inside electrical work must be completed by <br /> � <br /> electrician. <br /> �.�� C. Treatment System: <br /> Trenches: s.f. Mound <br /> ' Depth of rock below pipe " Rock bed dimensions 'x ' <br /> Drop Boxes Sand bed dimensions '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 /> trucked in <br /> The undersijned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, a�rees 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 c rra�ct. <br /> � <br /> Si�natureofApplicant: �� Date: 5 — � �"� � <br /> MPCA Certification No.: <br /> Staff Review: Approval �x, p iai <br /> , ' <br /> Reviewer: � �l``�.�c.__ �� ` Date: , __ � ,. C <br /> Reason for Denial: �' � <br />