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t <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: <br /> A. Tanks: , 3 Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) in) gal. 2) /an gal. 3)%p gal. <br /> B. Pump Station (if required) <br /> Pump make & model ,B/tee niiiy e/ </O (attach pump curve & <br /> literature); system design require .e, gpm at v,>, feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by installer electrician X <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensions /p 'x 5,,S' <br /> Drop Boxes Sand bed dimensions'/ 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. / / " <br /> Maniford Pipe Diam. c " <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 /> I� <br /> SignatureofApplicant7---,,,,_7 <br /> �`e �� Date: of 7 7 /9,6 <br /> MPCA Certification 0e9 <br /> Staff Review: Appro 2a1 Denial <br /> �� 7' <br /> Reviewer: ,10. /, ..,? /, Date: /`� <br /> Reason for Denial: <br />