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s <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 /> l Y(2 2. I will be installing the following: <br /> G .Precast Concrete C/- � ` : = <br /> A. Tanks: V Other Manufacturer� <br /> Tank Capacities: 1) A; ) gal. 2) /060 gal. 3)I gal. <br /> B. Pump Station (if required) <br /> Pump make & model. 4 Y (attach pump curve & <br /> literature); system design requires L/` gpm at z:°: feet of head. <br /> High water alarm make & model Lcve./ AL,)e=3715 . 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: s.f. (Mound <br /> Depth of rock below pipe " Rock bed dimensions /0 'x SD ' <br /> Drop Boxes Sand bed dimensions 7 'x S 2_' <br /> Distribution Box Pressure Dist. Pipe Diam. ,'/z." <br /> Maniford Pipe Diam. Z" " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> X 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 /> Signature ofApplicant: L s_ Date: I g-q 4-- <br /> MPCA Certification No.: f' !` <br /> Staff Review: Approv. De ial <br /> Reviewer: /At/ / y Date: <br /> Reason for Denial: <br />