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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 design inc ` g the Ciry Orono . <br /> Septic System Approval Cover Sheet. S <br /> R�` <br /> � <br /> � ., 2. I will be installing the following: � �� ��� ' ����-�' <br /> A. Tanks: recast Concrete f/ Other ��Manuf turer �Z�S <br /> Tank Capacities: 1) � gal. 2) a� gal. 3) �oo� gal. <br /> B. Pump Station (if required) <br /> Pump make & model �� (attach pump curve & <br /> literature); system design requires _�p gpm at �_ feet of head. <br /> High water alarm make & model /�,,,�u,,,, S'`�-N�f�� • Outside <br /> electrical work to be completed by installer �--e�ectrician <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 �0 'x SS' <br /> Drop Boxes Sand bed dimensions �l( 'x�' <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: 6 <br /> MPCA Certification No.: � �s <br /> , <br /> Staff Review: Approv Denial <br /> Reviewer: Date• D���� <br /> Reason for Denial• <br />