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t <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> ‘,- -- <br /> 1. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> , � <br /> / <br /> 2. I will be installing the following: <br /> A. Tanks: ? Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) .mal. 2 gal. 3) i-gal. <br /> B. Pump Station (if required) 6) <br /> Pump make & model oqi 5 H, A. /! attach pump curve & <br /> literature); system design requires Sr gpm at / feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by installer electrician )(— <br /> other <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Tre. ent System: <br /> enches: s.f. X Mound <br /> Depth of zck . ow pipe " Rock bed dimensions /0 'x fie' <br /> D .. :axes Sand bed dimensions V 'x/o$' <br /> Distributii Box Pressure Dist. Pipe Diam. ,2 "" <br /> Maniford Pipe Diam. d2. " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> X (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: - Date: y ` <br /> MPCA Certification No.: ?� 67 <br /> Staff Review: Approv 1 Denial <br /> Reviewer: / <br /> ' 2j.. ;% ------- Date: 17/-- 1-7-7 <br /> Reason for Denial: <br />