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A > <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 e following: ii <br /> A. Tanks: _ Precast Concrete _ Other Manufacturer eller <br /> Tank Capacities: 1) o�00 gal 2) /�F� gal. 3) leo b <br /> B. Pump Station (if required) attachum curve & <br /> Pump make & model Q�La /nG �. A jd m at p feet of head. <br /> literature); system design requires � gP -- — Outside <br /> High water alarm make & model /,,r.oF! 1 A e <br /> electrical work to be completed by installer _�e electrician <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: Mound <br /> Trenches: s.f. <br /> Depth of rock below pipe <br /> Rock bed dimensions /0 'x 7 <br /> Drop Boxes Sand bed dimensions &'x C-O ' <br /> Distribution Box Pressure Dist. Pipe Diam. i 1 zn" <br /> Maniford Pipe Diam. L <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 <br /> andccordance certrtfies thatth the ordinances of the all statements made on this lty and the <br /> appl cation <br /> regulations of the State of Minnesota, <br /> are complete, true and correct. <br /> S ignature of Applic ant: 4.DZ7 <br /> Date: <br /> MPCA Certification No.:_ <br /> Staff Review: Approval Denial <br /> c <br /> Reviewer: Date: <br /> Reason for Denial: <br />