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4 <br /> i <br /> GNOTE: Applicant must irutial 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 /> 'i A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal. 3) gal. <br /> B. Pum Station (if re uired) <br /> P q <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 /> v�� <br /> � `� C. Treatment S stem: <br /> C�� y <br /> � Trenches: s.f. �� Mound � � <br /> � � Depth of rock below pipe Rock bed d'unensions x <br /> � Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. �" <br /> Maniford Pipe Diam. v� " <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 /> regµlations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant: J l/� (./���� Date: ���' ���� <br /> MPCA Certification No.: <br /> Sta�f Review: Approv 1 ,,� Denial <br /> Reviewer: Date: ��� `' /� <br /> Reason for Denial• <br />