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r <br /> 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 desi?n includin� the Ciry of Orono <br /> � Septic System Approval Cover Sheet. <br /> 2. I will be installin; the followin�: <br /> A. Tanks: �/'precast Concre[e Other Manufacturer C���S <br /> Tank Capacities: 1) 04 0 gal. 2) po o �al. 3) �pop gal. <br /> B• Pump Station (if required) .3 8?� <br /> Pump make & model �s�o�.L� - c,p—d S (attach pump curve & <br /> literature); system desi�n requires �� gpm at !5 feet of head. <br /> . High water alarm make & model �,,,��.�oR ,��,,,,;F.'� Outside <br /> • electricaI work to be completed by installer electrician t� <br /> ocher . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> � Trenches: (,(�o s.f. Mound <br /> Depth of rock below pipe � Z " Rock bed dimensions 'x ' <br /> � Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: �borro�ved 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 cercifies that all statemenu made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant: ✓I Date: � S O� <br /> MPCA Certification No.:_�� `��" <br /> Staff Review: Approval � Denial <br /> � Revie�ver: Date: �' ���� <br /> Reason for Denial• <br />