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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. 1 will be installit3B the following: <br />A. Tanks: !/ Precast Concrete _ Other Manufacturer <br />Tank Capacities: 1) /&Iy gal. 2) ,cpou gal. 3) / 0ey gal. <br />B. Pump Station (if required) WEoSN &a 4yoc <br />Pump make & model 4> r0 31/ "14 IA (attach pump curve & <br />literature); system design requires �_ gpm at a?,dl 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 /0 'x�' <br />Drop Boxes Sand bed dimensions j S 'x 7,0 'Ate• <br />Distribution Box Pressure Dist. Pipe Diam. Pa. <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 andcegt. /? _ Z-11 <br />Signature of Applicant. X Date: g' '21-f r-/ <br />MPCA Certification No.:_�n- <br />Staff Review: Approval _ 7`- Denial <br />Reviewer: Date: <br />Reason for Denial: <br />