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� � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> c,, - � <br /> l. 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: t/ Precast Concrete Other Manufacturer �4�--�n <br /> Tank Capacities: 1)�'3vU gal. 2) � gal. 3) `,�; gal. <br /> B. Pump Station (if required) <br /> Pump make & model ��o� � ► ��z � -� � (attach pump curve & <br /> literature); system design requires �_ gpm at �_ feet of head. <br /> High water alarm make & model �z:.,-L (�,� Outside <br /> electrical work to be completed by , installer �Celectrician <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 �_'x�' <br /> Drop Boxes Sand bed dimensions�'x c>�Z ' <br /> Distribution Box Pressure Dist. Pipe Diam. (_�" <br /> , Maniford Pipe Diam. Z " <br /> � s�lc c� <br /> D. Final Cover/Topsoil to be: borrowed from site (' <br /> (show location on site plan) <br /> trucked in <br /> The undersi�ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, a�rees 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 /> _ � —� <br /> Si natureofApplicant: ��`' Date: —r� "��-� <br /> g <br /> MPCA Certification No.: � 7- �% <br /> ; <br /> Staff Review: Ap��q al Denial <br /> ' � ' �- ��--c�� <br /> Reviewer: / ��t'� Date: <br /> Reason for Denial: <br />