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NOTE: Applicant 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 Sheet. <br /> � � 2. I will be installinQ the followin�: <br /> A. Tanks: �recast Concrete Other Manufacturer �V�-�. S <br /> Tank Capacities: 1) �S� gal. 2) l�,Sv gal. 3) ((�v gal. <br /> B. Pump Station (if required) <br /> Pump make & model (r��Ld�� - 3� � I (attach pump curve & <br /> literature); system desi�n requires S� opm at 3 v feet of head. <br /> Hi�h wa[er alarm make & model p�},,,�L�.(vc2 �`,�,<.,,,,, ;�.• Outside �_ <br /> � electrical work to be completed by installer electrician �-� <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions j a 'x 7(0 ' <br /> Drop Boxes Sand bed dimensions �; 'x �U ' <br /> Distribution Box Pressure Dist. Pipe Diam. � " <br /> Maniford Pipe Diam. 1�S " <br /> D. Final Cover/Topsoil to be: 1/ borrowed from site <br /> , /(show location on site plan) <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 /> , <br /> Si�natureofApplican[: � Date: � 3 G � <br /> MPCA Certification No.: �'� �,S <br /> Staff Review: Approval Denial <br /> � Revietiver: '�Z,��,G�i{, � Date: 7�- 7�'O� <br /> JVc�7'e �o� �7cl.ti,�+ ���-f-►c -�-A� Ks ►o �e �J S <br /> �=t o se fiz� l-�o�S� ,� 5 %'G sSo�l3l p� <br /> , <br />