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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 /> .1 � <br /> r 2. I will be installing the following: <br /> A. Tanks: �Precast Concrete Other Manufacturer a�w� � <br /> Tank Capacities: 1) }� � gal. 2) ( � L gal. 3) �3 gal. <br /> B. Pump Station (if required) <br /> Pump make & model l�� ���� M���� � (attach pump curve & <br /> literature); system design requires .3`� gpm at � ( _ feet of head. <br /> High water alarm make & model L�L�\ �+�c�.r� . Out�e <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 l' 'x ��'�' <br /> Drop Boxes Sand bed dimensions `l 'x I � � <br /> Distribution Box Pressure Dist. Pipe Diam. 1��" <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 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 corr t. <br /> SignatureofApplicant: � <br /> ' Date: S �� `�l S <br /> MPCA Certification No.: !(�� <br /> Staff Review: Approval Denia <br /> Reviewer: i��/ Date: ���� <br /> Reason for Denial• <br />