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� <br /> . <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) �� Sal• 2) /� gal. 3)/� gal. <br /> B. Pump Station (if required) a�ch um curve & <br /> Pump make & model �/yf � P P <br /> literature); system design requires y�; gpm at 3� 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: 66y 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. <br /> �� <br /> Maniford Pipe Diam. " <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 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 /> ' ` Date: �f�O—S.�'� <br /> SignatureofApplicant: �o�� l� <br /> MPCA Certification No.: �,S/� <br /> Staff Review: Approval D �� <br /> Reviewer: Date: �`���` J — <br /> Reason for Denial: . <br />