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~ ' � <br /> - . <br /> NOTE: Applicanc rriusc initial alI spaces. Fill in all appropriace 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 Sheet. � <br /> 2. I will be installin� the followinQ: <br /> A. Tanks: � precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) Qal. 3) Qal. <br /> � o � <br /> B• Pump Station (if required) <br /> Pump make & model � q� ��� (attach pump curve & <br /> literature); system desi�n requires �_ gpm at ��_ feet of head. <br /> , Hi�h �vater alarm make & model _ � ��t�( Outside <br /> � electrical work to be completed by installer �_ electrician <br /> other IrLside electrical work must be completed by <br /> electrician. <br /> C. Treatmen[ System: 3O� <br /> Trenches: s.f. �_ Mound � <br /> Depth of rock below pipe " Rock bed dimensions /o 'x //Z <br /> Drop Boxes Sand bed dimensions 'x�.�.. , �-r <br /> Distribution Box Pressure Dist. Pipe Diam. .,�" � <br /> Maniford Pipe Diam. /%:._" <br /> D. Final Cover/Topsoil to be: �_ 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 [hat all statements made on this application <br /> are complete, true and correct: <br /> ; <br /> Si�natureofApplicant: Date: � �-- –�j'— �� <br /> MPCA Certification No.:_ ,�� - <br /> Staff Reviesv: Approv Denial <br /> ReFietiver: iG'(� D . �� <br /> ate. / ��{� <br /> Reason for Den.ial: <br />