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•' .e � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> ��G'� 1. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> � �j 2. I will be installing the following: <br /> A. Tanks: � Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) � gal. 2) p 0 gal. 3) 150(7 gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires 55.5 gpm at 2� ' feet of head. <br /> High 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. �C Mound <br /> Depth of rock below pipe " Rock bed dimensions �'x 75 ' <br /> Drop Boxes Sand bed dimensions��'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. �,5_" <br /> Maniford Pipe Diam. '� " <br /> D. Final Cover/Topsoil to be: x borrowed 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 /> SignatureofApplicant: ��L Date: �S—��� <br /> MPCA Certification No.: f �� � <br /> Staff Review: Ap oval Denial <br /> Reviewer: � �K�r,t� Date: 7'S-0� <br /> Reason for Denial: <br />