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. <br /> . . . � <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 includin� the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin� the following: <br /> A. Tanks: 1C Precast Concrete Other Manufacturer ��c��s?� <br /> Tank Capacities: 1) ! w gal. 2) )crc; gal. 3) ( vo gal. <br /> B. Pump Station (if required) <br /> Pump make & model ME 3 � /�c-���Z (attach pump curve & <br /> literature); system design requires � ;pm at /� feet of head. <br /> Hijh water alarm make & model �;_�d���,.� Outside <br /> � ' electrical work to be completed by �C' installer electrician ?C <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 �0 'x ��' sra- <br /> Drop Boxes Sand bed dimensions 'x ' ��37 <br /> Distribution Box Pressure Dist. Pipe Diam. (;1�, " iOZ <br /> Maniford Pipe Diam. �_" <br /> D. Final Cover/Topsoil to be: � bonowed 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 /> SignatureofApplicant: �'�� ��vt., Date: `�2 � � c 7 <br /> MPCA Certification No.: �S(o <br /> Staff Review: Approval Denial <br /> �' <br /> Reviewer: - ---� Date: <br /> Reason for Denial: <br />