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M1 4 <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 desijn includi.n� the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> � .2. I wiIl be insta in; the followinQ: <br /> A. Tanks�� precast Concrete Other Manufaccurer�������1���� � <br /> Tank Capacittes: 1) /2_-�ogaI. 2) �o a o oal. � o � <br /> J �) � C aal. <br /> B• Pump Station (if required) � -�� <br /> Pump make & model iQ Y, i'YJe i�:-u. �-� 1�l (attach pump curve & <br /> literature); system desi�n requires�l�X�,5 opm at �� feet of head. <br /> , Hi;h �va[er alarm make & model ,,L�.v�;/ �L,9ti�-v Outside <br /> • electrical work [o be completed by installer eleccrician <br /> other Ins'de electrical work must be completed by <br /> electrician. � <br /> (�� : <br /> C. Trea ment System:��� <br /> � Trenches:��� S,f, Mound <br /> Depth of rock below pipe " Rock bed dimensions 'x ' <br /> Drop Boxes Sand bed dimensions 'x ' <br /> �� Distribution Box Przssure Disc. Pipe Diam. <br /> „ <br /> (C� c�',,� a C ���-�L � � Maruford Pipe Diam. „ <br /> � <br /> D. Final Cover/Topsoil to be: � borrowed from site <br /> (show location on site plan) � <br /> trucked in <br /> The undersijned hereby appIies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> reguIations of the State of Minnesota, and certifies that all statements made on th.is application <br /> are complete, true and correct. <br /> Si�natureofApplican : � v <br /> Date: i�' Z' " ,� � <br /> MPCA Cercification No.:G �9 � - <br /> Staff Review: Appro � e�� � <br /> ReY-iezver: � � -� - � <br /> Date:_ ���S���� <br /> Reason for Den.ial: <br />