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. <br /> NOTE: Applican[ must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> .—� �L._ <br /> 1 <br /> 1. I have received a copy of the systzm design includin� the Ciry of Orono <br /> r'.. ' <br /> Septic System Approval Cover Sheet. <br /> � �' 2. I will be installin, the followin�: <br /> A. Tanlcs: ✓�recast Concrete Other Manufacturer�-�-''`�"'� <br /> Tank Capacities: 1) �� gaI. 2) �; gal. 3) /� gal. <br /> B. Pump Station (if required) �j� `P,, <br /> Pump make & model ��`��� 5'// e� C�;,,�-( (attach pump curve & <br /> literature); system desi�n requires '� gpm at %C feet of head. <br /> Hi�h water alarm make & model Lc�� (-a�� Outside <br /> • ' electrical work to be comple[ed by installer ,�– electrician <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: j <br /> Trenches: s.f. �Mound <br /> Depth of rock below pipe " Rock bed dimensions L(�'x �' <br /> Drop Boxes Sand bed dimensions �� 'x�z <br /> Distribution Box Pressure Dist. Pipe Diam. / %" <br /> Maniford Pipe Diam. z " <br /> D. Final Cover/Topsoil to be: �borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersijned 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 chat all statements made on th.is application <br /> are complete, true and correct. <br /> � <br /> SignatureofApplicant: � " Date: � '- z��'� <br /> � <br /> MPCA Certification Ir�o.: (� `��� <br /> Staff Review: Approv Denial <br /> Reviewer: � - � <br /> Date• ��� ��,X . <br /> Reason for Denial: <br />