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. � <br /> N01'E: 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 /> A. Tanks: Precast Concrete Other Manufacturer �� <br /> Tank Ca acities: 1 � al. 2) pK gal. 3) ov gal. ;' <br /> � -Li.-g � -/� _� <br /> _ �,�,.��N - <br /> B. Pump Station (if required) <br /> Pump make & model ��,,1� w�bs�r� (attach pump curve & <br /> literature); system design requires 39 gpm at l b feet of head. <br /> High water alarm make & model Ce.fe le,e.w� . Outside <br /> ' electrical work to be completed by installer �lectriciari ���� ��`�� ` <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 (U 'x� <br /> Drop Boxes Sand bed dimensions /U.6 'x yl ' <br /> Distribution Box Pressure Dist. Pipe Diam. /%" <br /> Maniford Pipe Diam. z " <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 /> SignatureofApplicant: Date: �I'^�S �J6 <br /> MPCA Certification No.: �f � <br /> Staff Review: Appr val J�� Denial <br /> Reviewer: Date• �� <br /> Reason for Denial• <br />