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� <br /> NOT'E: Applicant rriust initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. . <br /> � � 1. I have received a co 'o ' <br /> py of the system desi�n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> � .2. `I �v' Q . <br /> iIl tie mstallin� the followin�; <br /> A. Tanks: 't-� precast Concrete Other Manufacture��rw��� <br /> Tank Capacities: 1),��gat. 2) �3�_ gal, ;)�� gal. <br /> B. Pump Station (if required) <br /> Pump make & model W�c�.SI I f� ��� �"P' (attach pump curve & <br /> literacure); system desi�n requires 39 gpm at Z('o feet of head. <br /> Hi�h water alarm make & model _ [��(��� 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 dimensions ,�'x tX ' <br /> Distribution Box Pressure Dist. Pipe Diam. /�L " <br /> Maniford Pi�e Diam. �_" <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> �(show 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, 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 that all statemenu made on this application <br /> are complete, true and correct: <br /> SignatureofApplicant: Date: �o '—Z�l�g <br /> MPCA Certif cation No.:_ (p �C� - <br /> Staff Review: Approv � De ial � <br /> Revietiver: Date: ���g� <br /> Reason for Denial: <br />