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, <br /> NOTE: Applicant must uutial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system design includin� the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires gpm at feet of head. <br /> Hi�h water alarm make & model Outside <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 �c� '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: bonowed from site <br /> �how location on site plan) <br /> rucked 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 cort�ect. <br /> � <br /> �" � ' � �.- <br /> SignatureofApplicant: J/-.i,° ,��,,��c.�� �-J��;�„_ Date: -� 1 <br /> MPCA Certification No.: � ��- ' �=� <br /> Staff Review: Approva Denial <br /> <. <br /> Reviewer: . ;,��:/rl,`�'�-� Date: ��Z.-� � <br /> Reason for Denial• <br />