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� <br /> � <br /> N01�: Applicant rriust initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> � 1. I have received a copy of the system design includin� the City of Orono <br /> Septic System Approval Cover Sheet. <br /> �� <br /> � 2. I �viIl be instal�lin��-the f�llowin�: <br /> A. Tanks: 1/Precast Concrete Other Manufacturer Lr��� S <br /> Tank Capacities: 1) tZSc� gaI. 2) �Z�� �al. 3) � Z�U ga1. <br /> B. Pump Station (if required), <br /> Pump malce & model (,y� � ,<< 's C-I�c S (attach pump curve & <br /> literature); system design rzquires � opm at I�3 feet of head. <br /> Hi;h water alarm make & model �,�,,_,��;,t S�,•:..,,;i•� Outside <br /> � ' electrical work to be completed by installer electrician Z� <br /> ocher . Inside electrical work must be completed by <br /> eleccrician. <br /> C. Treatment System: ` <br /> Trenches: s.f. �� Mound <br /> Depth of rock below pipe " Rock bed dimensions 1 U 'x L� ' <br /> Drop Boxes Sand bed dimensions �'x_�' <br /> Distribution Box Pressure Dist. Pipe Diam. �,S ° <br /> Maniford Pipe Diam. Z;p " <br /> D. Final Cover/Topsoil to be: 1/ borrowed from site <br /> (show location on site pla�) <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 the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> Si�natureofApplicant: �17�i ✓�.�? Date: i Z <br /> L � y <br /> MPCA Certification I�'o.: � �, `-lj - <br /> Staff Review: Appr val x Denial <br /> � Revietiver: �� / � <br /> Date:�� — <br /> Reason for Denial: <br />