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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 design including the City of Orono � <br /> Sepric System Approval Cover Sheet. <br /> ��d 2. I will be installing the following: <br /> A. Tanks: �C Precast Concrete _ Other Manufacturer <br /> Tank Capacities: 1) �JUU gal• 2) 1�J�ro gal. 3) �gal. <br /> B. Pump Station (if required) � <br /> Pump make & model /� �� (attach pump curve & <br /> literature); system design requires 3/ gpm at /�_ feet of head. <br /> High water alarm make & model P u w,,�c o . Outside <br /> electrical work to be completed by installer electrician� <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatrnent System: <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions ! 0 'x `�� ' <br /> Drop Boxes Sand bed dimensions y0 'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. 2 <br /> �� <br /> Maniford Pipe Diam. �lZ " <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 /> Si tureofApplicant:_����C.� y� GL��`y` Date: �U'b —� �� <br /> � <br /> MPCA Certification No.: <br /> Staff Review: Approv Deni <br /> Reviewer: Date: a�/ <br /> Reason for Denial: <br />