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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> y-e S 1. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> yes' - 2. I will be installing the following: <br /> A. Tanks: 2 Precast Concrete _ Other Manufacturer f Pecs q' <br /> Tank Capacities: 1) /VW gal. 2) /u.. gal. 3) /cup gal. <br /> B. Pump Station (if required) <br /> Pump make & model 6l') E (/0 (attach pump curve & <br /> literature); system design requires 3 c, gpm at J feet of head. <br /> High water alarm make & model G' t,,v 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 /> 3 Trenches: 1/63 s.f. Mound <br /> Depth of rock below pipe / " Rock bed dimensions 'x <br /> Drop Boxes Sand bed dimensions -----'x—' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: 1( 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 /> SignatureofApplicant: U (�J ° <br /> Date: <br /> MPCA Certification No.: <br /> Staff Review: Approv Denial <br /> Reviewer: //261/7/2/z----" Date: 27/ g--1??•' <br /> Reason for Denial: <br />