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I - <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),/�_ gal. 2)/go�' gal. 3) !? S gal <br /> B. Pump Station (if required) � � t i � <br /> Pump make & model �>�.,J, C�.��� (attach pump curve & <br /> literature); system design requires � �r 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. k Mound <br /> Depth of rock below pipe " Rock bed dimensions �_'��' <br /> Drop Boxes Sand bed dimensions�'xy�-= <br /> Distribution Box Pressure Dist. Pipe Diam.l�" <br /> Maniford Pipe Diam. L <br /> D. Final Cover/Topsoil to be: bonowed 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 /> - � � � � �i <br /> Signature ofApplicant:!�� ���/ `� � Date: �l���� <br /> � <br /> MPCA Certification No:: ���� �'� �!' <br /> , <br /> „ <br /> , <br /> Staff Review: Approv Denial <br /> ,/> — . ' <br /> �` <br /> Reviewer: � ���'`—' Date: ��7�9l� <br /> Reason for Denial: <br />