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w ,. <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) /000 gal. 2)/GILD gal. 3)l006 gal. <br /> B. Pump Station (if required) <br /> Pump make & model /4 ee/l (attach pump curve & <br /> literature); system design re4uires 3/ gpm at — —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. Mound <br /> Depth of rock below pipe " Rock bed dimensions JO 'x y/ ' <br /> Drop Boxes Sand bed dimensions /7 'x 7/ ' <br /> Distribution Box Pressure Dist. Pipe Diam. / " <br /> /Maniford Pipe Diam. aZ " <br /> D. Final Cover/Topsoil to be: V 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 /> Signature of Applicant: "5 de% 1 Date: c5 c� <br /> MPCA Certification No.: DV <br /> Staff Review: Approv Denial e--/e-/-?5 <br /> .410111. <br /> Reviewer: �,� Date: <br /> Reason for Denial: <br />