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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: k1C Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 1 W gal• 2) !2w gal. 3) j�?� gal. <br /> B. Pump Station (if required) <br /> Pump make & model l�" � v _ (attach pump curve & <br /> literature); system design requires � 7 gpm at �R feet of head. <br /> High water alarm make & model �n�,L�.� . Outside <br /> electrical work to be completed by installer electrician �C <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions !v 'x 6 p ' <br /> Drop Boxes Sand bed dimensions �'x 4� ' <br /> Distribution Box Pressure Dist. Pipe Diam. ��/� '� <br /> Maniford Pipe Diam. z- <br /> „ <br /> D. Final Cover/Topsoil to be: X bonowed 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. <br /> SignatureofApplicant: ��-n-� ���~- Date: `'1- l f" �� <br /> MPCA Certification No.: � � � Z-- <br /> Staff Review: Approval � Denial <br /> Reviewer: <br /> Date• �� <br /> Reason for Denial' <br />