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� <br /> � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> ��1�-� 1. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> '1 � <br /> ��, �-L 2. I will be installing the following: �� <br /> A. Tanks: `�3 Precast Concrete _ Other Manufacturer � � �1 S <br /> Tank Capacities: 1) i z �� gal. 2) � z ?� gal. 3) � gal. <br /> B. Pump Station (if required) <br /> Pump make & model /� �.S (attach pump curve & <br /> literature); system design requires 3 �1 gpm at ) �' feet of head. <br /> High water alarm make & model ��'���,��c;� Outside <br /> electrical work to be completed by installer electrician '�C <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 d'unensions %`- 'x�' <br /> Drop Boxes Sand bed dimensions `/_� 'x��'� <br /> Distribution Box Pressure Dist. Pipe Diam. //Z" <br /> Maniford Pipe Diam. 2- " <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 /> �� � �C= ` <br /> i �� % (, (�; � <br /> , <br /> SignatureofApplicant: �� ��-�r�?—������ ���ti Date: � � ! <br /> MPCA Certification No.: <br /> Staff Review: Approval �`'-- Denial <br /> ,�, <br /> ,� � , � <br /> Reviewer: � �� ` �---- Date: %`-��`� ��f <br /> Reason for Denial• <br />