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1 <br /> NOTE: Applican[ must initial all 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 Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin� the followin�: <br /> A. Tanks: �( Precast Concrete �,( Other Manufacturer <br /> Tank Capacities: 1) (�S^p gal. 2) r:p_ �al. 3) gal. <br /> =?Pi�'�� %;��',:_: <br /> B. Pump Station (if required) <br /> Pump make & model �Xi 5��r�q (attach pump curve & <br /> literature); system desi�n requires opm at feet of head. <br /> Hi�h water alarm make & model 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 '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: borro�ved from site <br /> (show location on site plan) <br /> trucked in <br /> The undersijned hereby appIies 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 /> regula[ions of the State of Minnesota, and certifies that all statements made on this appiication <br /> are complete, true and corr <br /> Si�natureofApplican[: � Date: Q - — <br /> MPCA Certificatio .• $ �� <br /> � <br /> Staff Review: Appr va Denial <br /> � Reviesver: Date: �0���� <br /> Reason for Denial: <br />