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r � <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 daesign including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> .2. I will be installing the following: <br /> A. Tanks: — recast Concrete _ Other Manufacturer c3uL4�S <br /> Tank Capacities: 1) l000 gal. 2) loac, gal. 3) Cc?oa gal. <br /> B. Pump Station (if required) <br /> Pump make & model C—Z,S _ .P -3931 (attach pump curve & <br /> literature); system design requires 'Z 1' gpm at Z feet of head. <br /> High water alarm make & model Ouside <br /> electrical work to be completed by_ installe electriciaPetecd' <br /> other . Inside electrical work m p by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe Rock bed dimensions /d <br /> X. <br /> Drop Boxes Sand bed dimensions ZWIX ' <br /> Distribution Box Pressure Dist. Pipe Diam. 1." <br /> Maniford Pipe Diam. -Z,o " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> how 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 /> 5ignatureofAppIicant: Date: <br /> MPCA Certification No.: G� <br /> Staff Review: Approval Denial <br /> Reviewer: .Er,�r,] Date: 7-31-oO <br /> Reason for Denial: <br />