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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 design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: 3_ Precast Concrete 1/ Other Manufacturer ErUC1 S <br /> Tank Capacities: 1) (OW gal. 2) 1000 gal. 3) /000gal. <br /> B. Pump Station (if required) <br /> Pump make & model W f}''JJc yfp (attach pump curve & <br /> literature); system design requires yr) gpm at 'may feet of head. <br /> High water alarm make & model Outside <br /> electrical work to be completed by installer electrician 1/ <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 /0 'x.5-5' <br /> Drop Boxes Sand bed dimensions go 'x 86' <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: Ac2 - -- <br /> ��'�� Date: � � '3! <br /> MPCA Certification No.: • <br /> g <br /> Staff Review: Appr al Denial <br /> • <br /> Reviewer: �>> r / , Date: 0"X"?? <br /> Reason for Denial: <br />