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.* <br /> � <br /> � <br /> NO'TE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> � � <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 insta�llin�-the following: ; <br /> A. Tanks: !/ Precast Concrete Other Manufacturer L`fC/�.�, S <br /> Tank Capacities: 1) �� ,v�� gal. 2) CG�� gal. 3) lde� gal. <br /> B. Pump Station (if required <br /> Pump make & model �,%�s. �z�F/ - � (attach pump curve & <br /> literature); system design requires C%{� gpm at Z� feet of head. <br /> Hi?h water alarm rnakP & model �„r�� 5�, `-u.r;C` Outside ,� <br /> electrical work to be completed by installer electrician C._-�"� <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 d'unensions �'x��' <br /> Drop Boxes Sand bed dimensions �'x�_' <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 /> �y�, <br /> SignatureofApplicant: �.�vy �4-�-�C� Date: -7 l� �/� <br /> MPCA Certification No.: �j � <br /> Staff Review: Approv Denial <br /> Reviewer: ;�� �—"- Date• �/ /' ,� <br /> Reason for Denial• <br />