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N01�: Applicant must initial alI spaces. Fill in all appropriate blanks, check all appropriate' <br /> boxes. <br /> 1. I have received a copy of the system desi�n includin� the City of Orono <br /> Septic System Approval Cover Shee[. <br /> 2. I �viIl be installing the followin�: . <br /> A. Tanks: � Precast Concrete O[her Manufacturer ��`,�> �:�s 7` <br /> Tank Capacities: 1) /����° gal. 2) �� �'�> gal. ;)����-, gal. <br /> B. Pump Station (if required) <br /> Pump make & model -� � /�� (attach pump curve & <br /> Iiterature); system desi�n requires opm at �_ feet of head. <br /> Hi�h water alarm make & mode � � %/ Outside <br /> • ' electrical work to be completed by installer electrician G--� <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 �n 'x,�',�' <br /> Drop Boxes Sand bed dimensions �'x �� ' <br /> Distribution Box Pressure Dist. Pipe Diam. ,C jz " <br /> Maniford Pipe Diam. v2 '' " <br /> D. FinaI Cover/Topsoil to be: borrowed from site <br /> (show location on site pla�) <br /> � trucked in <br /> The undersi�ned 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 /> regulacions of the State of Minnesota, and certifies that all s[atements made on th.is application <br /> are complete, true and correct. <br /> Si�natureofApplicant:���l��� � < < <br /> Date: �r "� " � c� <br /> MPCA Certification No.: �� � - <br /> Staff Review: Approv Den'al <br /> � Revietiver: Date: � ��_ <br /> Reason for Denial: <br />