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NOTE: 'Applicant rriust initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. . <br /> � . <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 �viIl be�instaflin� the.following: � � � � <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 12'S�gaI. 2)�_ gal. 3)�2'S`�gal. . <br /> - B• Pump Station (if required) <br /> Pump make & model . (attach pump curve & <br /> literacure); system design requires gpm at feet of head. <br /> High �vater aIarm make & model . Outside <br /> • ' electricaI 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 /> Depch of rock below pipe " Rock bed dimensions � 0 �'X Lp�� <br /> Drop Boxes � Sand bed di.mensions�t�'x$� ' - <br /> Distribution Box Pressure Dist. Pipe Diam. � � " <br /> � .Maniford Pipe Diam. Z` n <br /> D. Final Cover/Topsoil to be: ��borrowed from site <br /> (show location on site plan)- - <br /> trucked in <br /> The uadersigned 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 chat all statements made on this application <br /> are complete, true and correct: <br /> Si�natureofAppli�ant• �h • �� Z . <br /> Date• <br /> MPCA Certification No.: . � � - � <br /> Staff Review: A r Denial . . � <br /> � Revietiver: Date: /� ��'� �� � <br /> Reason for Denial: <br />