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{ v . � <br /> NOTE: 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 design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: � Precast Concrete Other Manufacturer <br /> Tank Capacities: 1)/�r� gal. 2) �t'G' gal. 3) /C����' gal. <br /> B. Pump Station (if required) <br /> Pump make & model ��/f� /��i'l�kU/t'J�T.�- (attach pump curve & <br /> literature); system design requires � gpm at _� feet of head. <br /> High water alarm make & model L.�� Ar�k��► . 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 �' <br /> Distribution Box Pressure Dist. Pipe Diam. 2"' " <br /> Maniford Pipe Diam. Z�r " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> � trucked in <br /> The undersigned hereby applies to the Ciry 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: Date:�j`"��`/ � <br /> �- <br /> MPCA Certification No.: G`��Z <br /> Staff Review: Approval � Denial <br /> Reviewer: � Date: �"�/ �_____—. <br /> Reason for Denial: <br />