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� <br /> � <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 installin e following: <br /> , <br /> A. Tanks: Precast Concrete Other Manufacturer�.4 YW�� <br /> Tank Capacities: 1) rc�c,v gal. 2) �mo gal. 3) Jc�'v gal. <br /> B. Pump Station (if required) <br /> Pump make & model �o��� W�031 l � (attach pump curve & <br /> literature); system design requires �_ gpm at !S 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 /> C. Treatment System: <br /> Trenches: s.f. ound <br /> Depth of rock below pipe " Rock bed dimensions t o 'x�' <br /> Drop Boxes Sand bed dimensions � I 'x�-l� z.' <br /> Distribution Box Pressure Dist. Pipe Diam. 1 %" <br /> Maniford Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> �ow 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 /> SignatureofApplicant: Date: �:-z.5 —�� <br /> MPCA Certification No.: �C/� <br /> Staff Review: Approval Denial <br /> � <br /> Reviewer: Date• � <br /> Reason for Denial: <br />