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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 installine the following: <br /> A. Tanks: V---P-recast Concrete _ Other Manufacturer <br /> Tank Capacities: 1)/ eP gal. 2) /ego gal. 3) /3 gal. <br /> B. Pump Station (if required) we c 3 1 1 <br /> Pump make & model (z, d (attach pump curve & <br /> literature); system design requires 3q gpm at 13 feet of head. <br /> High water alarm make & model 44ve�4r"4- 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 Lo'x GY' <br /> Drop Boxes Sand bed dimensions 39 'x_f-7 A--t• <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> Maniford Pipe Diam. 2 " <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 /> SignatureofApplicant: Date: <br /> MPCA Certification No.: r J y <br /> -141 <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />