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� , <br /> NOTE: �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 desi�n inciudin� the Ciry of Orono <br /> � Septic System Approval Cover Sheet. � <br /> � .2. I will be installin� thz followinQ: � � � <br /> ; A. Tanks: ;� Precast Concrete Ocher Manufacturer ��r���,�- �e <br /> Tank Capacities: 1) �-o.. �aL `'Ast� <br /> 2) , 5<<' Jal. �) =�'c� gal.° <br /> ���r�uf-;�,�� <br /> B• Pump Station (if required) <br /> Pump make & model . (attach pump curve & <br /> litera[ure); system desi�n requires gpm at feet of head. <br /> . Hi�h water alarm make & model Outside <br /> • electrical work to be completed by installer electrician <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> ' C. Trea[ment System: <br /> � Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions >o 'x ��' <br /> Drop Boxes Sand bed dimensions �'x�s �; ' - <br /> Distribution Box Pressure Dist. Pipe Diam. ,x+ " <br /> Man.iford Pipe Diam. ;�'� " <br /> D. Final Cover/Topsoil to be: � borrowed from site <br /> (show location on site plan)- <br /> x 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 wich the ordinances of the City and the <br /> regulations of the State of Miruiesota, and certifies that all statements made on this application <br /> are complete, true and corre�t: ; - <br /> \ <br /> Si�natureofApplicant: � �°� � _ ���'� , ; ' ��,Z, �' :�-; <br /> . "� �� Date: ����:,'���/ <br /> �—� <br /> MPCA Certification No.:�����' - � <br /> Staff Review: A roval Denial . � <br /> � . � <br /> Rerietiver: Date: f Q – 2$–J� <br /> Reason for Denial: <br />