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NOTE: �Applicant rriust initial aII spaces. Fill in alI appropriate blanks, check all appropriate <br /> boxes. . <br /> ,.��� - <br /> '� ��� I. I have receiv <br /> ed a copy of the system desi�n includin� the City of Orono <br /> Septic System Approval Cover Shee[. • <br /> ��. _ : <br /> � . .2. I �viil be�installin� � �ollowinQ:,. <br /> � �... � . <br /> A. Tanics: - rrecast Concrete Ocher Manufacturer,��f����✓ <br /> Tank Capacities: I) �,� gal. 2) rc�,�;� �al. ;)� Q2L. <br /> a <br /> � - B• Pump Station (if required) <br /> Pump make & model �L c�S? i 1'z ��P ` (attach pump curve & <br /> Iiterature); system desi�n requires 3� gpm at � � feet of head. <br /> , Hi;h water aIarm make & model _ �;,.�. (W•-� Outside <br /> • electrical �vork to be completed by installer e/ eleccrician <br /> other . 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 5�' <br /> Drop Boxes � Sand bed dimensions �'x�' - <br /> Distribution Box Pressure Dist. Pipe Diam. _L" <br /> � _Man.iford Pipe Diam. 2 " <br /> D. Final Cover/Topsoil to be: ✓borroived from site <br /> � (show location on si[e pian}- � <br /> trucked in <br /> The undersijned hereby appiies to the Ciry of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance �vith the ordinances of the Cicy and the <br /> reguiations of the State of Minnesota, and cenifes that aIl statements made on this application <br /> are complete, true and correct: <br /> � � <br /> Si�natureofApplicant_�� � ; � <br /> . . � Date: ��� 1 �—� % <br /> MPCA Cercification No.: �,� � � - � <br /> Staff Reriezv: Appr Deni . � <br /> � ]E�e�iezver: " 52.:,� Date: � � . . <br /> . �-- . � <br /> Reason for Denial: <br />