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y <br /> NOT'E: 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 includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> 2. I �vill be installin� the followin�: � � <br /> A. Tanks: _ Precast Concrete �Other Manufacturer o f�,�-�o <br /> Tank Capacities: 1) �p gal. 2) isod �al. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model G-.�,,��/c ���'p S"///-� (attach pump curve & <br /> literature); system desi�n requires �_ apm at 1 � feet of head. <br /> � �' t°� , Hi�h water aIarm make & model ,Q..�, � o � S� ^. Outside <br /> �/v������._.----�-'� � electrical work to be completed by ri'installer electrician <br /> ��--'""� other . Inside electrical work must be completed by <br /> ' electrician. <br /> C. Treatment System: '� �r-�asS" f'�' �' �-�'"'``'� <br /> Trenches: s.f. � <br /> Depth of rock below pipe " Rock bed dimensions �'x (Z' <br /> . Drop Boxes � �X � <br /> � <br /> Distribution Box Pressure Dist. Pipe Diam. Z " <br /> Maniford Pipe Diam, z, " <br /> D. Final Cover/Topsoil to be: _� 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 /> SignatureofApplicant: '� �_ Date: /z.-3 a-�7 <br /> MPCA Certification No.: / Z..� <br /> Staff Review: App oval Denial <br /> � Revietiver: Date: �v?''�,,�� - �� <br /> Reason for Denial: <br />