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A <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 install' the following: <br /> A. Tanks: _ Precast Concrete Other Manufacturer 6 u 4� S <br /> Tank Capacities: 1) Z50 gal. 2) zoo gal. 3) (�S gal, <br /> B. Pump Station (if required), -1011 <br /> Pump make & model J✓1 ^ - lie' (attach pump curve & <br /> literature); system design requires gpm at W- feet of head. <br /> High water alarm make & model �1,1,�,40� �`; ;� Outside <br /> • ' electrical work to be completed by installer electrician 4-`- <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 'x <br /> Drop BoxesSand bed dimensions <br /> 'x <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Nianiford Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: V/1" 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: <br /> Date: -2v G o <br /> MPCA Certification No.: <br /> Staff Review: Ap v Denial <br /> Reviewer: 8i ./ Date: -25-VD <br /> Reason for Denial: <br />