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� � <br /> NOTE: Applicant must initial all spaces. Fill in all apgropriate blanks, check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system desi�n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be install�in�a e followin�: <br /> A. Tanks: �/Precast Concrete Other Manufacturer � � <br /> �S <br /> Tank Capacities: 1) �d gaI. 2) �ood �al. 3)loop ga1. <br /> B• Pump Station (if required) <br /> Pump make & model `,.a���� -- �,��� S"' (attach pump curve & <br /> literature); system desi�n requires �� gpm at ; Z. fee[ of head. <br /> Hi�h water alarm make & model �� S� .,,�,,,�;,✓�.� 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 f(� 'x�' <br /> Drop Boxes Sand bed d'unensions ��'x$�' <br /> Distribution Box Pressure Dist. Pipe Diam. C� S' <br /> Maniford Pipe Diam. ` �v " <br /> D. Final Cover/Topsoil to be: �borrowed from site <br /> , /(show location on site plan) <br /> v trucked in <br /> The undersi�ned hereby applies to the City of Orono for issuance of a sep[ic 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 cenifies that all statements made on this application <br /> are complete, true and correct. <br /> Si�natureofApplicant: � Date: � 2c�� <br /> _� <br /> MPCA Certification I�To.: �� <br /> Staff Review: Approval Denial <br /> � Reti-iewer: � Date: � ��J—Cr0 <br /> Reason for Denial: �— <br />