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NOTE: Applicanc must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system desijn includin� the Ciry of Orono <br /> Septic System Approval Cover Shee[. <br /> (/ 2. I wiIl be instal�lin�Q e followin�: <br /> A. Tanks: //precast Concrete _ Other Manufacturer b'��-�S <br /> Tank Capacities: 1) IZS� gai, 2) ��ao �al. 3) rZ,�"� gal. <br /> B• Pump Station (if required) ��� <br /> Pump make & modzl (�y-t,�l.��� S —3�7I ' (attach pump curve & <br /> literature); system design requires � 9 gpm at /� feet of head. <br /> Hi�h water alartn make & model �NC/��yt S"�;�,,;jr,���. Outside <br /> • electrical work to be completed by installer electrician �� <br /> other _�, Inside �lectrical wnrk n,,,�r he ��;��,�=�d �� <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions /f, 'x (��' <br /> Drop Boxes Sand bed dimensions _�'x � ' <br /> Distribution Box Pressure Dist. Pipe Diam. � " <br /> Maniford Pipe Diam. 2— " <br /> D. Final Cover/Topsoil to be: �borro�ved from site <br /> �{show location on site plan) <br /> 1� trucked in <br /> The undersi�ned hereby appIies 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 the State of Minnesota, and certifies that all statements made on th.is application <br /> are complete, true and correct. <br /> QivnahirunfAnnl:..n.,�. - � !� <br /> __a'_--___....___t.i,�L..�..5�. r� Date: /`7 2v�( <br /> T <br /> MPCA Certif cation No.:_ � � S <br /> Staff Review: Approval � Denial <br /> r--- <br /> �}� / <br /> � Revietiver: � � _ � � � � <br /> . d�� }�, " , ;,�.�� f <br /> 7 � 1 '-�. -�r' Date: i �� �� � <br /> Reason for Denial: <br />