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NOTE: Applican[ must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> � <br /> � 1. I have received a copy of the system design includin� the City 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) ,:,��5'�' gal. 2) %r'�;'G'�al. 3) , '� gal. <br /> B. Pump Station (if required) �,E�O <br /> Pump make & model ,� �� �r�' (attach pump curve & <br /> literature); system desi�n requ es 3G gpm at � feet of head. <br /> Hi�h water alarm make & model �L ✓ 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 � '� ��� �L/� �� <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 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 Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> Si�nature ofApplicant: `�,,�<,,,,, ��y��;��r�� Date: �� <br /> � <br /> MPCA Certification No.: �'7� <br /> Staff Review: Appr val Denial <br /> Reviewer: Date: ����� <br /> : " � <br /> Reason for Denial: <br />