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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 including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: n <br /> A. Tanks: '} Precast Concrete Other Manufacturer O�r-�c=<<Sfi ��w�, <br /> Tank Capacities: 1) 1 �ct;' gal. 2) e?��� gal. 3) � �'�.�- gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & � <br /> literature); system design requires �.�` gpm at _� ? feet of head. �� r <br /> � <br /> Hi�h water alarm make & model ',-z�z��. _ _ 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. � Mound <br /> Depth of rock below pipe " Rock bed dimensions �f�J 'x �� �'� ' <br /> Drop Boxes Sand bed dimensions �it'x I,''% ' <br /> Distribution Box Pressure Dist. Pipe Diam. i ' ', " <br /> Maniford Pipe Diam. `_ " <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 complete, true and correct. <br /> > ��� �. � Date: ��- � �, <br /> SignatureofApplicant: ,;'�,�c�-,%- ��� ""'�' � ` �- <br /> MPCA Certification No.: <br /> Staff Review: Appro al Denial <br /> Reviewer: �= �/.��", '%��� Date: ���������_ <br /> Reason for Denial• <br />