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�.. <br /> NO'I'E: Applicanc rriust initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> �� <br /> �`�� � �, 1. I have received a co of the s stem desian ' ' Q <br /> PY y � uicludin� the Ciry of Orono <br /> Septic System Approval Cover Shee[. <br /> �� 2. I wiIl be installin� the followin�: <br /> A. Tanks: �precast Concrete Other Manufaccurer �%��w�� <br /> Tank Capacities: 1) l� gai. 2) ��`�; gal. 3) �i�� gal, <br /> B. Pump Station (if required) � <br /> Pump make & model � _ � . �- �/L h,( � <br /> S� (�l)�.�� 11 (attach pump curve & <br /> literature); system desi�n requues 3 y gpm at � Z_ feet of head. <br /> Hi�h water aIarm make & model Ltiv�%,crn Outside <br /> • electrical work to be completed by installer �lectrician <br /> ocher Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. 1�' Mound <br /> Depch of rock below pipe " Rock bed dimensions %D 'x(��' ' <br /> Drop Boxes Sand bed dimensions �-f5" 'x l/z ' <br /> Distribution Box Pressure Dist. Pipe Diam. /'�z " <br /> Maniford Pipe Diam. z- �� <br /> D. Final Cover/Topsoil to be: '� borrowed from site <br /> (show location on site pla�) <br /> trucked in <br /> The undersi�ned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, a�rees to do aIl work in strict accordance with the ordinances of the City and the <br /> reguIations of the State of Mi.nnesota, and certifies that all statements made on this application <br /> aze complete, true and correct. <br /> Si�natureofApplicant:-� �{-,� _ _ , <br /> Date: �7 c� - �t � <br /> MPCA Certif cation No.:_ („ � () - <br /> Staff Revie«•: Approv Den'al <br /> � Revietiver: - Date: ��CJ �� <br /> Reason for Denial: <br />