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a � <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 Approval Cover Sheet. <br /> 2. I will be instal,lin,g the following: <br /> A. Tanks: ����Precast Concrete Other Manufacturer <br /> Tank Capacities: 1)� gal. 2) �;o gal. 3) 3�c� gal. <br /> B. Pump Station (if required) � � L���G� <br /> Pump make & model c.��0 3 i� �3 ��f'� (attach pump curve & <br /> literature); system design requires�:3`l gpm at �_ feet of head. <br /> High water alarm make & model s,e�e j ,��:�, Outside <br /> electrical work to be completed by installer electrician�_ <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 /O 'x �S�' <br /> Drop Boxes Sand bed dimensions �_'x�'�1��- <br /> Distribution Box Pressure Dist. Pipe Diam. /�L " <br /> Maniford Pipe Diam. �_" <br /> D. Final Cover/Topsoil to be:��`�'�� �orrowed 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: 2— Date: �"�� -� �f <br /> MPCA Certification No.: ��� <br /> Staff Review: Approval Denial <br /> Reviewer: Date: � <br /> Reason for Denial: <br />