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� <br /> ► <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxe . <br /> � 1. I have received a co of the s stem desi�n includin� <br /> ` PY Y � � the City of Orono <br /> Septic System Approval Cover Sheet. � <br /> i - 2. I will be installin� ttie followin;: <br /> A. Tanks: �ecast Concrete Other Manufacturer Cc��� f S <br /> , Tank Capacities: 1) �O vv ?al. 2) /o o v gal. 3) lOd� gal. <br /> B. Pump Station (if required) <br /> Pump make & model ,� � - g I L'Po ttach pump curve & <br /> literature); system desi�n requires �_ a t �_ feet of head. <br /> High water alarm make & model �},,,�F/a,� �;t,,,T;/_;•� . Outside <br /> • ' electrical work to be completed by installer electrician � <br /> ocher � . 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 �'x y S' <br /> Drop Boxes Sand bed dimensions �'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. j,� " <br /> Maniford Pipe Diam. Z;p " <br /> D. Final Cover/Topsoil to be: borro�ved from si[e <br /> J�ow 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, 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 /> SignatureofApplicant:��2� <br /> Date: r <br /> MPCA Certification No.: �� <br /> Staff Review: Appr va Denial <br /> � Revie�ver: Date: �—��� <br /> Reason for Denial: <br />