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NOTE: Applicanc must irutial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> "�� 1. I have received a copy of the system desi�n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin, the followin�: <br /> A. Tanks: � Precast Concrete _ Other Manufacturer�E�� ��'�''�� <br /> Tank Capacities: 1)��Oe, gaI. 2) o � �al. 3)l��p gal. <br /> B. Pump Station (if requi ed) <br /> Pump make & model ���� ��-�} 1 � (attach pump curve & <br /> litera[ure); system desi�n requires � � gpm at �_ feet of head. <br /> Hi�h water alarm make & model L� / �}�,r�R utside <br /> • ' electrical work to be completed by installer " electrician <br /> other Inside electrical work must be comp eted by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions 10 'x �o' <br /> Drop Boxes Sand bed dimensions..�-�'j 'x��"' <br /> Distribution Box Pressure Dist. Pipe Diam. 1 %L," <br /> Maniford Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: X borro�ved from site <br /> (show location on site plan) <br /> trucked in <br /> The undersi�ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, a�rees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of [he State of Minnesota, and certifies [hat all statements made on th.is application <br /> are complete, true and ect. <br /> Si�natureofApplicantL---- ��,C����,�,�Y� Date• — � ' <br /> . � �� <br /> MPCA Certification No.: � �'J8 <br /> Staff Review: Approv 1 Denial <br /> � Revie�ver: � ,�----' Date: <br /> Reason for Denial: <br />