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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) MOOgal. 2) /19CD gal. 3) MO gal. <br /> B. Pump Station (if required) <br /> Pump make & model n , 4is ' (attach pump curve & <br /> literature); system design requires gpm at _ feet of head. <br /> High water alarm make & model 140),y,,v- scjP ► 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. V Mound <br /> Depth of rock below pipe " Rock bed dimensions 10 'x <br /> Drop Boxes Sand bed dimensions ,-/-q 'x <br /> Distribution Box Pressure Dist. Pipe Diam. /h <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: Vborrowed from site <br /> / (show location on site plan) <br /> V 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 ofApphcant: .7�7 1 Date: G///75 <br /> MPCA Certification No.: <br /> Staff Review: Approval Denial <br /> Reviewer: /A- ice/i -- Date: .S /.) <br /> Reason for Denial: <br />