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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 />or€ <br />A. Tanks: Precast Concrete <br />- Tank Capacities: Vi/0(7y gal. <br />Other ManufacturerX^^<^‘*''*^ <br />2)il^gal.3) ____gal,* <br />/?cv>y» /iP \ <br />B. Pump Station (if required) ^ <br />Pump make & model jjJCb • (attach pump curve & <br />literature); system design requires gpm at So feet of head. <br />High water alarm make dc 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. <br />Depth of rock below pipe <br />' Drop Boxes <br />____Distribution Box <br />D. Final Cover/Topsoil to be: <br />Mound <br />Rock bed dimensions /O *x75^ * <br />Sand bed dimensions //? *x * <br />Pressure Dist. Pipe Diam. / ^ * <br />Maniford Pipe Dlain. * <br />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 iiutallation <br />permit, agrees to do all work in strict accordance with the ordinances of the City and the <br />reg;ulations of the State of Minnesota, and certifies that all statements made on thb application <br />are complete, true and correct. <br />SignatureofApplicant: _____ Date; Co *~ I ? <br />MPCA Certification No.: C g? M O . • " <br />? • <br />Staff Review: Appro^ <br />Reviewer: <br />Reason for Denial: <br />Date;