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NOTE: Applicant must initial alI 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 Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> � 2. I �vill be installin� the followin�: _ <br /> A. Tanks: � precast Concrete Other Manufacturer <br /> Tank Capacities: 1)�� gal. 2) /vo a gal. 3)�a,� gal. <br /> B. Pump Station (if required) <br /> Pump make & model G�.�� . � (attach pump curve & <br /> literature); system desi�n requires �_ gpm at l� feet of head. <br /> High water alarm make & model A1�a� , Outside <br /> � ' electrical work to be completed by �C installer �_ electrician <br /> ocher . Inside electricai 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 t o 'x N 1 ' <br /> Drop Boxes Sand bed dimensions �t/ 'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. Q. " <br /> Maniford Pipe Diam. �,` " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on si[e plan) � <br /> _� trucked in <br /> The undersi�ned hereby appIies 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 Ci[y and the <br /> regulations of the State of Miruiesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant , ,�c?�����, �, G� _2� -- `�'� <br /> Date: - <br /> MPCA Certification No.: � �� � � <br /> Staff Review: Approv Denial <br /> � Revietiver: � ��Q,�� . <br /> Date: <br /> Reason for Denial: <br />