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� <br /> y <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 Maaufacturer ����v �',Gq;NE <br /> Tank Capacit�es: 1)� g�• 2) ldoog�• 3) l000 g�• <br /> B. Pump Station (if required) � <br /> Pump make & model a;?�� Y►1�.��o i d (attach pump curve & <br /> literature); system design requires � gpm at � feet of head. <br /> High water alarm make & model / z,�s � i4�a e•-r� . Outside <br /> electrical work to be completed by installer ?C 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 " Rock bed dimensions /O 'x�' <br /> Drop Boxes Sand bed dimensions �ll 'x 6`A' <br /> Distribution Box Pressure Dist. Pipe Diam. � `�z. " <br /> Maniford Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: �_ borrowed from site <br /> (show location on site plan) <br /> x trucked in <br /> The undersigned hereby applies to the Ciry 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: )C� - Z Z � c1 �- <br /> MPCA Certification No.: Q�� <br /> Staff Review: Approv Denial <br /> Reviewer: <br /> Date: �a "� <br /> Reason for Denial: <br />