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1♦ <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 installing the following: <br /> A. Tanks: �Precast Concrete Other Manufacturer <br /> ' Tank Capacities: 1)� gal• 2)� gal. 3)��gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires ` gpm at �� feet of head. <br /> High 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 " Roc bed dimensions�'x�' <br /> Drop Boxes Sand bed dimensions �'x�o`� <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 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: Date: ��"��`� <br /> MPCA Certification N . � � <br /> Staff Review: Approval Deni <br /> Reviewer: Date:�` 'i�� <br /> � <br /> Reason for Denial• <br />