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�t ` <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 �/ Ca-✓<;�'r��� <br /> Tank Capacities: 1)/',��• gal. 2)/OZr1� gal. 3)/�� gal. <br /> B. Pump Station (if required) �''�-y�' � r <br /> Pump make & model /�y�/,ec�� %� -,��,;�i�-�(J�ch pump curve & <br /> literature); system design requires � gpm at /G ` feet of head. <br /> High water alarm make & mode � ,�✓�.;-,�Z _ 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. G!Mound <br /> Depth of rock below pipe " Rock bed dimensions /� 'x SS�' <br /> Drop Boxes Sand bed d'unensions 3� ''x �..5�' <br /> Distribution Box Pressure Dist. Pipe Diam. �_" <br /> Maniford Pipe Diam. �" <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (s w 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 conect. <br /> � � <br /> SignatureofApplicant:,��� i � .�..--.,�� Date: �� �S�- S�� <br /> MPCA Certification No.: j�/G, <br /> � <br /> Staff Review: Approv �— Denial <br /> -- � �-�.- -`��,���� . <br /> Reviewer: '�f� Date• � �` / i ,� <br /> Reason for Denial• <br />