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• <br /> , <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. � <br /> Cl. I have received a copy of the system design includin� the City of Orono Septic <br /> System Approval Cover Sheet. <br /> , <br /> 2. I will be installi ?the followin': <br /> A. Tanks: �Precast Concrete Other Manufacturer �q-vk,ivJ ��✓�s� <br /> Tank Capacities: 1) /3B0 �al. 2) /3oJ aal 3) /SaU gal <br /> u�=r <br /> B. Pump Station(if required) <br /> Pump make& model $N/y0�'�e��� (attach pump curve 8c <br /> literature); system design requires ��f gpm at S�D feet of head. <br /> High water alarm make& model sS 2��..b�s . Outside <br /> electrical work to be completed by installer �ectrician other. <br /> C. Treatment System: / <br /> Trenches: s.f. ✓ Nlound Z_ <br /> Depth of rock below pipe " Rock bed dimensions �o ' x 3 9 ' <br /> Drop Boxes Sand bed dimensions�3 ' x b� ' <br /> Distribution Box Pressure Dist. Pipe Diam. /��z " <br /> Manifold Pipe Diam. Z " <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 permit, <br /> a�rees to do all work in strict accordance with ordinances of the Gity and the regulations of the State <br /> of 1Vlinnesota,and certifies that all statements mad on this application are complete,true and correct. <br /> SijnatureofApplicant S Date: �— � `� � � <br /> NIPCA License No. � T L/ <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval " Den' <br /> ��V9���er: ��it2' � � l0� �� <br /> fl�eaSOl1 fOd' �eII➢��: <br />