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. � <br /> NOT�: Applicant rriusc irutial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. . <br /> /�l��l. I have received a copy of the system desiQn includinQ <br /> Septic System Approval Cover Sheet. J � �e Clry of Orono <br /> .2. I �vill be ins lin� the followinQ: <br /> A. Tanks: i� precast Concrete Other Manufacturer <br /> Tank Capacities: 1) �vo gaI. 2) �vvo �al. 3) ��� � val. <br /> o , <br /> B. Pump Station (if required) <br /> Pump make & model _�',�„A\c� ,,�;��,s I! (attach pump curve & <br /> literature); system design requires :3g gpm at z a feet of head. <br /> Hi�h water aIarm make & model�L��.J Outside <br /> • electrical work tv be completed by installer _� eleccrician <br /> ocher . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. � Mound <br /> Depch of rock below pipe " Rock bed dimensions �'x S�c'�° <br /> Drop Boxes Sand bed dimensions �'x ��' <br /> Distribution Box Pressure Dist. Pipe Diam. j �� " <br /> Maniford Pipe Diam, z " <br /> D. Final Cover/Topsoil to be: borrocved from site <br /> (show location on site pla�) <br /> _,� trucked in <br /> The undersi�ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance wi[h 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�natureofApplicant: �� �� ` <br /> Date: .�//-�% <br /> MPCA Certification No.: /�/'a2 - � <br /> Staff Reviesv: Approval � Denial <br /> Revieiver: � — � � � <br /> Date: ��� <br /> � <br /> Reason for Denial: <br />