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r <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 installing the following: <br /> A. Tanks: '( Precast Concrete _ Other Manufacturer <br /> Tank Capacities: 1) /000 gal. 2) Men gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model /A Y 141„16,1p t a C f 4 (attach pump curve & <br /> literature); system design requires 1-0, gpm at j / feet of head. <br /> High water alarm make & model t / 'wt. /) . 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. 7\ Mound <br /> Depth of rock below pipe " Rock bed dimensions /p 'x ? S ' <br /> Drop Boxes Sand bed dimensions .5 'x /// <br /> Distribution Box Pressure Dist. Pipe Diam. A" " <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, d ce ies at all statements made on this application <br /> are complete, true and correct. <br /> SignatureofA licant: Date: <br /> PP /h,A, <br /> MPCA Certification No.: '2 9,0 <br /> Staff Review: Approv. Den'al <br /> • <br /> Reviewer: <br /> . Date: <br /> Reason for Denial: <br />