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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 co of the system design including <br /> PY Y � � the City of Orono <br /> Septic System Approval Cover Sheet. <br /> .2. I will be installing the w' g• <br /> � f0110 1r1�. �ajrwir•J <br /> A. Tanks: .-'Precast Concrete _ Other Manufacturer <br /> Tank Capacities: 1) l o dal. 2) 1 o co gal. 3) /Oco gal. <br /> B. Pump Station (if required) 1 <br /> Pump make & model We'031.1 (6.A 3 410` (attach pump curve & <br /> literature); system design requires aFl gpm at --�-- feet of head. <br /> High water alarm make & model 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 16 'x Sb ' <br /> Drop Boxes Sand bed dimensions -go <br /> Distribution Box Pressure Dist. Pipe Diam. 1 'iz " <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 /> Signature ofApplicant:_ Date: ' _ — <br /> MPCA Certification No.: <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />