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� %► <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> Q� 1. I have received a copy of the system design includin� the City of Orono . <br /> - Septic System Approval Cover Shee[. <br /> 2. I will be installin� the followin�: <br /> A. Tanks: ✓Precast Concrete Other Manufacture#�"�°`"'�"J <br /> Tank Capacities: 1) /3vv ?aI. 2) b � gal. 3)�_ gal. <br /> B. Pump Station (if required) <br /> Pump make & model G��la. w��S�� ��- (attach pump curve & <br /> literature); system design requires �_ gpm at Z 2 feet of head. <br /> Hi�h water alarm make & model (,��.e Iq,c,,,,� 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. �ound <br /> Depth of rock below pipe " Rock bed dimensions ��'x f�" <br /> Drop Boxes Sand bed dimensions �(p 'x ld�' <br /> Distribution Box Pressure Dist. Pipe Diam. ���'z " <br /> Maniford Pipe Diam. 2_ " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> / �show location on site plan) � <br /> r/� trucked in <br /> The undersigned 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 /> SignatureofApplicant: Date: � �-- Z_� r�i �7 <br /> MPCA Certification No.: � <br /> Staff Review: Approv �� Denial <br /> � Reviewer: , 1�--�, r�a+P• /l�''��—�7 <br />