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�' <br /> NOTE: 'Applican[rriust initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> �—'� � . : <br /> � � 1. I have received a co of the 'Q • <br /> py system desi�n includi.n� the Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> �I� .2. I will be�installinQ �e'followinQ: � . . <br /> �� , . <br /> � <br /> A. Tanks: recast Concrete Other Manufaccurer �� y '���� <br /> Tank Capacities: 1) gaI. 2) gal. 3) /G�p gaL° <br /> �'`'�'`P <br /> - B• Pump Station (if required) <br /> Pump make & model(�� �.'� j/ (attach pump curve & <br /> literacure); system design requires �/ opm at "z / feet of head. <br /> High water alarm make & model (��,�. /,�,,y,,, , Outside <br /> • ' electrical work to be completed by installer electrician <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> ' C. Treacment System: <br /> � Trenches: _______ S,f, �� �JMound <br /> Depth of rock below pipe Rock bed dimensions /C1 'x�N f ' <br /> � Drop Boxes - Sand bed dimensions �v 'x�' - <br /> Distributian Box � Pressure Dist. Pipe Diam. f �z " <br /> � ,Maniford Pipe Diam. v ° <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan)- <br /> �trucked in <br /> The undersigned hereby appIies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in stricc accordance with the ordinances of the City and the <br /> . regulations of the State of Minnesota, and certifies that alI statements made on this application <br /> are complete, true and correct: <br /> SignatureofApplicant: Date: `� ` � � � � �`j <br /> MPCA Certif cation No.: �jr �� . - - � <br /> Staff Reriew: Ap�r�ival Denial � . <br /> � � � . <br /> " ReFieiver: Date: /�•—(S-- •Y`9' � <br /> Reason for Denial: <br />