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� 3 <br /> NOTE: Applicant mus[ initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. - <br /> � <br /> 1. I have received a copy of the system desijn includin� the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin�Q e followin�: <br /> A. Tanks: i/Precast Concrete _ Other Manufacturer �vC,C � <br /> Tank Capacities: 1) (��e� �al. 2) /r�ao �al. 3) dr v gal. <br /> B. Pump Station (if required� <br /> Pump make & model �,-��,G��S - L'l�G S (attach pump curve & <br /> literature); system desian requires �� opm at �, � feet of head. <br /> Hi�h water alarm make & model �,,,��� s�;,,,,,i:•--�-�_. 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 �'x.�' <br /> Drop Boxes Sand bed dimensions ��x�' <br /> Distribution Box Pressure Dist. Pipe Diam. /%" <br /> Maniford Pipe Diam. 2 " <br /> D. Final Cover/Topsoil to be: �orrowed from site <br /> �jshow 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 /> Si�natureofApplican[: ��Z� �� Date: l'u <br /> � �� <br /> MPCA Certification No.: �- �,�` <br /> Staff Review: Approva Denial <br /> _ ..,��� . <br /> Reviewer: �-������� <br /> Date: <br /> Reason for Denial: <br />