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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxes. <br />1. 1 have received a copy of the system design including the City of Orono <br />Septic System Approval Cover Sheet. <br />2. 1 will be installing the following: <br />A. Tanks: /_/precast Concrete _ Other Manufacturer c �� S <br />Tank Capacities: 1) i0co gal. 2)i=gal. 3) ,—r, gal. <br />B. Pump Station (if required) <br />Pump make & model 4A.5, 5,-J N - `/ (attach pump curve & <br />literature); system design requires 3 7 gpm at feet of head. <br />High water alarm make & model S:..i.r. Outside <br />electrica! work to be completed by _ installer _ electrician v' <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 /o 'x SU <br />_ Drop Boxes Sand bed dimensions yS'xF_' <br />Distribution Box Pressure Dist. Pipe Diam. <br />/Maniford Pipe Diam. 2' " <br />D. Final Cover/Topsoil to be:y 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 />SignatureofApplicant: /�-"r-n 1,/./�.T� Date: S Z "S <br />MPCA Certification No.: <br />Staff Review: Approval Denial <br />Reviewer: — Date: <br />Reason for Denial: <br />