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I'^t- �a► <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> �n 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: '/ p�A�� <br /> A. Tanks: a Precast Concrete Other Manufacturer �t��� � <br /> Tank Capacities: 1)/v�O gal. 2) !o b0 gal. 3) gal. <br /> B. Pump Station (if required) t�o� <br /> Pump make & model A,� �. IV����! �c� (attach pump curve & <br /> literature); system design requues �,� gpm at a� feet of head. <br /> High water alarm make & model �1 �.q Outside <br /> electrical work to be completed by , installer electricia <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 r� 'x,�' <br /> Drop Boxes Sand bed dimensions �'x2�' <br /> Distribution Box Pressure Dist. Pipe Diam. /'It " <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 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: /O— 7� 9� <br /> MPCA Certification No.: �98 <br /> Staff Review: Appr val Denial <br /> Reviewer: s�!/ Date: � .f <br /> Reason for Denial: <br />