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�_ <br /> . <br /> NOTE: Applicant rriust initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> �1. I have received a co of the s stem desiQ ' ' o <br /> PY y �n uicludm� the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installinQ e followin�: <br /> A. Tanks: Precast Concrete Other Manufaccurer �C�u�S <br /> Tank Capacities: 1) l2So gal. 2) l0 �n gal. 3) l ZSO gal. <br /> B• Pump Station (if required) <br /> Pump make & model (�,� �,,S - Wco S f� (attach pump curve & <br /> literature); system desi�n requires � Z epm at _�_ feet of head. <br /> Hi�h water alarm make & model /�„z� �; � �� Outside <br /> • ' elec[rical work to be completed by installer �/'elec[rician <br /> �cher . I��;iue electrical work must be completed by <br /> electrician. <br /> C. Treatment System: / <br /> Trenches: s.f. f� Mound <br /> Depth of rock below pipe " Rock bed dimensions �'x (�Z ' <br /> Drop Boxes Sand bed dimensions �'x �' <br /> Distribution Box Pressure Dist. Pipe Diam. �" <br /> Maniford Pipe Diam. �" <br /> D. Final Cover/Topsoil to be: t/ borro�ved 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 Ciry 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�n�:i:r�Qf�+YF?ic��t: ���v�l'?� � -_ i�ate: "Z <br /> 7 �c� <br /> MPCA Certification No.: � I S <br /> Staff Review: Ap rov X Denial <br /> � Revie�ver: ` � � <br /> Date: 7— 6- E�O <br /> Reason for Denial• <br />