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N01�: 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 desi�n includin; the City of Orono <br /> Septic System Approval Cover Sheet. � <br /> � 2. I �vill be installinQ the followin;: ;� <br /> A. Tanks: �recast Concrete Other Manufacturer�/f�����✓ <br /> Tank Capacities: 1) � gal. 2) ebv gal. 3) /3� gal. <br /> : B. Pump Station (if required) <br /> Pump make & model (�JC�o�'(\ � (attach pump curve & <br /> literature); system desi�n requires '3q gpm at a S feet of head. <br /> Hi�h water alarm make & model C�.�e,(.�v�.--, Outside <br /> • ' electrical work to be completed by ,/�nstaller 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/o 'x �$�' <br /> Drop Boxes Sand bed dimensions ��6 'x�' <br /> Distribution Box Pressure Dist. Pipe Diam.�i-Z ° <br /> Maniford Pipe Diam. 2 " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> �/�w location on site plan) � <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 with the ordinances of the Ciry and the <br /> regulations of the State of Minnesota, and certifies that all statemenu made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant: Date: /C� -.Z 3—�j � <br /> MPCA Certifica[ion No.: � �o �Q <br /> Staff Review: Appr val De ial <br /> � Revie�ver: J Date:^��`"�3`� . <br /> Reason for Denial: <br />