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( � <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 desi�n includi.n� the Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> 2. I will be installin� the following: <br /> A. Tanks: �Precast Conc ete Other Manufactur r <br /> Tank Capacities: 1) /��gal. 2) `d� gal. 3)� gal. <br /> B. Pump Station (if required) <br /> Pump make & model � r'�'�-°��1�/�� (attach pump curve & <br /> literature); system desi�n requires gpm at �� feet of head. <br /> High water alarm make & model / �✓�2 A��(Lv►�• Outside <br /> � ' electrical work to be compieted by installer electrician .� <br /> ocher . Inside electrical work must be completed by <br /> electrician. � <br /> C. Treatment System: \ / <br /> . Trenches: s.f. �C Mound <br /> Depth of rock below pipe " Rock bed dimensions /� 'x �� <br /> Drop Boxes Sand bed dimensions �'x/�/ ' 3 7X�/;G <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 undersi?ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, a�rees 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: �_, . �cp��x �. Date: ���3— �` <br /> MPCA Certification No.: �y� <br /> Staff Review: Approval ,� Denial <br /> � Revie�ver: .y!� Date: �' <br /> Reason for Den.ial• <br />