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' i <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 installina the followina: <br /> A. Tanks: �3 Precast Concrete Other Manufacturer �E�f� �'��'�w E� <br /> Tank Capacities: 1)��'s� gal. 2) /�'OC' gal. 3) iZs c� gal. <br /> B. Pump Station (if required) <br /> Pump make & model R�� ���� ��-'"� �� (attach pump curve & <br /> literature); system design requires �—�— gpm at ��. feet of head. <br /> High water alarm make & model 1.,�����/ �f��e�u— • 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 di.mensions �_'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. 1 '�' " <br /> Maniford Pipe Diam. �'( " <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 Ciry 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:��� � ��'_____ <br /> MPCA Certification No.: ��� �'�`� <br /> Staff Review: Appro al Denial <br /> Reviewer: c Date: <br /> �-- -� <br /> Reason for Denial• <br />