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� ti <br /> NOT'E: 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: ,DQ�r���h <br /> A. Tanks: � Precast Concrete Other Manufacturer ��S-� <br /> Tank Capacities: 1) a�� gal. 2) � gal. 3) _��'�"pgal. <br /> B. Pump Station (if required) /✓�,��4�`S <br /> Pump make & model �r �(� �¢C / / (attach pump curve & <br /> literature); system design requires �_ gpm at :2CJ feet of head. <br /> High water alarm make & model ,���,l . Outsid� <br /> electrical work to be completed by installer electrician 1/ <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: 7� � s.f. Mound <br /> Depth�ock below pipe �" Rock bed dimensions 'x ' <br /> y -� t/ Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Maniford Pipe Diam. " <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 /> SignatureofApplicant: i��,�c,t.�r.,�, � �.v-- Date: �� <br /> MPCA Certification No.: ��� <br /> Staff Review: A �°val , Denial <br /> f � <br /> Reviewer: ��� Date: ��-�- ��`� _ <br /> Reason for Denial: <br />