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� J <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 including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanlcs: � Precast Concrete _ Other Manufacturer � / Y���i� <br /> Tank Capacities: 1) ��o gal• 2) �� gal. 3) %2 gal. <br /> B. Pump Station (if required) � <br /> Pump make & model �� �iY1 (attach pump curve & <br /> literature); system design r quires �f1 gpm at � feet of head. <br /> High water alarm make & model Outside <br /> electrical work to be completed by installer electrician �C <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> 198 C.�'h�� <br /> � Trenches: s.f. �� Mound <br /> Depth of rock be ow pipe �' Rock bed dimensions 'x ' <br /> � Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> �� <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: � bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City 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 /> . . � `_f�� �'� <br /> SignatureofApplicant: > > ��te: ` � <br /> MPCA Certification No.: ��' F �7 <br /> Staff Review: Approval Denial <br /> Reviewer: <br /> Date: ����`�� <br /> Reason for Denial: <br />