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� � <br /> NOTE: Applicant must uutial 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 /> / <br /> '� 2. I will be installing ollowing: � <br /> A. Tanks: recast Concrete Other Manufacturer E��.L S <br /> Tank Capacities: 1) r 2;�_' gal• 2) l���-,:-� gal. 3) ���: gal. <br /> B. Pump Station (if required) <br /> Pump make & model �'iI �s_ r �G' (attach pump curve & <br /> l�terat�re); system design req ires C .� gpm at 1:�_ feet of head. <br /> High water alarm make & model /�,�.-4!;'�F; `�_ : ; -� %'_ � 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. i;/ Mound �� X <br /> Depth of rock below pipe Rock bed dimensions / ' 6� ' <br /> Drop Boxes Sand bed dimensions �='x �v' <br /> Distribution Box Pressure Dist. Pipe Diam. ( ' z " <br /> Maniford Pipe Diam. Z' " <br /> D. Final Cover/Topsoil to be: '� bonowed 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 complet�, tiue und LorrPcr, _ <br /> SignatureofApplicant: �2�� /� —_ - Date: S � �/� <br /> �"- ,�- C' <br /> MPCA Certification No.: �'� ' S ��lk �S <br /> Staff Review: Approv � Denial <br /> Reviewer: <br /> ` �` " Date: �'��� /� <br /> Reason for Denial• <br />