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, <br /> NOTE: Applicanc must initial all spaces. Fill in all apprapriate 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 wiIl be installin� the followinQ: <br /> A. Tanks: ✓precast Concrete Other Manufacturer <br /> Tank Capacities: 1)� vo gai. 2) ���o�, �al. 3) i�c� gal. <br /> B. Pump Station (if required) �ot,�� <br /> Pump make & model G,6�o��� (attach pump curve & <br /> literature); system desi�n requires �%7 gpm at / 3 feet of head. <br /> Hi�h water alarm make & model 1�,,�c /�,� 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 f� 'x �� ' <br /> Drop Boxes Sand bed dimensions 3y� 'x 9�'' <br /> Distribution Box Przssure Dist. Pipe Diam. ��L " <br /> Maniford Pipe Diam. 2 " <br /> D. Finai Cover/Topsoil to be: borrowed from site <br /> /(show location on si[e plan) <br /> ✓ trucked in <br /> The undersijned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, a�rees 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�natureofAppIican[: Date: /o�Z� S�' <br /> MPCA Certification No.: � y�/ - <br /> Staff Review: Appr Denial <br /> � Reti-iesver: � — :;�. <br /> ,, Date:��^ �_ <br /> Reason for Denial: <br />