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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 includin� the City of Orono <br /> Septic System Approval Cover Shee[. <br /> r <br /> i � 2. I will be insta�ll�' the following: <br /> A. Tanks: (�' Precast Concre[e _ Other Manufacturer Gt�� (S <br /> Tank Capacities: 1) 125C� gai. 2) �Dc�U �al, ;) jzSp gal. <br /> B. Pump Station (if required) <br /> Pump make & model �--o�1-�S 3`��I ' �PO� (attach pump curve & <br /> literature); system desi�n requires � 9 apm at �_ feet of head. <br /> Hi;h water aIarm make & model _i�,,,�i�o,` 5�;�„�j�'� . Outside <br /> � ' electrical work to be completed by installer electrician L�� <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 j� '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 City 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 Miruiesota, and certifies [ha[ all statements made on this application <br /> are complete, true and correct. <br /> ._ ' <br /> SignatureofApplicant: � Date: Z '' 9 <br /> MPCA Certification No.: � <br /> 9 <br /> Staff Review: Approv Denial <br /> � Revie�ver: � � � - �' � <br /> Date: � � `r� <br /> Reason for Denial: <br />