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r 1 <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 installi�n the following: <br /> A. Tanks: ✓ Yrecast Concrete Other Manufacturer Yw �� <br /> Tank Capacities: 1) � gal. 2) �3C�gal. 3) ��. gal. <br /> ��P <br /> B. Pump Station (if required) <br /> Pump make & model {��,�1 Q W�d�< ( _ (attach pump curve & <br /> literature); system design requires �{Z gpm at �� feet of head. <br /> High water alarm make & model (.2� (c,�w� . Outside <br /> electrical work to be completed by installer �ctrician <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: � <br /> Trenches: s.f. t/ Nlound <br /> Depth of rock below pipe " Rock bed dimensions�0 'x�' <br /> Drop Boxes Sand bed dimensions �Z 'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. /iz " <br /> Maniford Pipe Diam. z-- " <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: Date: � J � � V� <br /> MPCA Certification No.: � � � <br /> Staff Review: Approval Denial <br /> Reviewer: Date• <br /> Reason for Denial: <br />