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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 installing the following: <br /> A. Tanks: )< Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) �Gpp gal. 2) f )A�al, 3) /D911�� I% ejh'ghee- <br /> (-) -;0016 <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires 4-0 gpm at ,;2.41 feet of head. <br /> High water alarm make & model Outside <br /> electrical work to be completed by installer electrician X <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensions /D 'x c5 ' <br /> Drop Boxes Sand bed dimensions 9Z. 'x 9� ' <br /> Distribution Box Pressure Dist. Pipe Diam. dQjiz " <br /> Maniford Pipe Diam. <br /> D. Final Cover/Topsoil to be: ;C 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 /> SignatureofAppIicant: y4q • _ <br /> � -` � Date: � 30 <br /> MPCA Certification No.: c <br /> Staff Review: Appr.val Denial <br /> Reviewer: Date: —745_? <br /> Reason for Denial: <br />