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4 <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 /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: (/Precast Concrete _ Other Manufacturer Gull, S <br /> Tank Capacities: 1) /ZSo gal. 2) l000 gal. 3) j ZSo gal. <br /> B. Pump Station (if require <br /> Pump make & model u Leo S 3 S 7/ - (attach pump curve & <br /> literature); system design requires -?9 gpm at 'Z 3 feet of head. <br /> High water alarm make & model Aqa2 Outside <br /> electrical work to be completed by installer electrician Z--' <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions l0 'x 6 ' <br /> Drop Boxes Sand bed dimensions � D 'x 9 ' <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> /Maniford Pipe Diam. Z, ' <br /> D. Final Cover/Topsoil to be: Z- 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 /> SignatureofApplicant: Date: z 5 %05' <br /> MPCA Certification No.: 3 4 <br /> Staff Review: Approval De i { <br /> Reviewer: 'J Date: <br /> Reason for Denial: <br />