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F� # <br /> 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 Approva' Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: 1� Precast Concrete Other Manufacturer �u��.s�s�eu5 <br /> Tank Capacities: 1) � 3w gal• 2) � gal. 3) �?� gal. <br /> B. Pump Station (if required) A,, <br /> Pump make & model �t, r'5 /"l� �� (attach pump curve & <br /> literature); system design equires �_ gpm at �� feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by i staller electrician �' <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. �_ Mouad <br /> Depth of rock below pipe " Rock bed dimensions �� 'x�' <br /> Drop Boxes Sand bed dimensions �'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. I�L " <br /> Maniford Pipe Diam. Z. " <br /> D. Final Cover/Topsoil to be: x borrowed from site <br /> (sl�ow 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 /> SignatureofApplicant:�'�� ✓�-�/� Date: 6 —/Z- `r..Sr <br /> MPCA Certification No.: <br /> Staff Review: Approval � Denial <br /> Reviewer: � Date• �i� <br /> Reason for Denial: <br />