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- <br /> � <br /> NOTE: Applicant must 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 including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> � � '�` ' 2. I will be installin; the followina: <br /> A. Tanks: ✓ Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) � � _ �a1• 2) - _ gal. 3) �;,�i�� gal. <br /> B. Pump Station (if required) <br /> Pump make & model /'„ ���� (,,;�-�;i I (attach pump curve & <br /> literature); system design requires ��> gpm at � �� feet of head. <br /> High water alarm make & model ; .�_�- !-<-�-.� . 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: 1 ���� s.f. Maund <br /> ,���`'`� Depth of rock below pipe " Rock bed dimensions 'x ' <br /> �� � !� �—' Drop Boxes Sand bed dimensions 'x ' <br /> � �; �� <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> Maniford Pipe Diam. " <br /> ��j;'� <br /> D. Final Cover/Topsoil to be: ` - borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees 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 /> -��<< < � � � Date: ' � - � � �,_ <br /> SignatureofArrlicant: ` <br /> �,:, �- <br /> i �- <br /> MPCA Certification No.: � � � <br /> Staff Review: Appro� �� De ial <br /> `�' ,� Date: �J�` / ��:) <br /> Reviewer: / <br /> Reason for Denial: <br />