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t' <br />NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check ell 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: Y Precast Concrete _ I)ther Manufacturer <br />Tank Capacities: 1) j 3 W gal. 1)13 ,.ro gal. 3) 1 3w gal. <br />B. Pump Station (if required) <br />Pump make & model it1 E SID (attach pump curve & <br />literature); system design requires � cf gpm at 2< feet of head. <br />High water alarm make & model (,.y-,e.Z;, 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 it Rock bed dimensions IO <br />Drop Boxes Sand bed dimensions Lo,'x__jX <br />Distribution Box Pressure Dist. Pipe Diam. <br />Maniford Pipe Diam. Z- <br />D. <br />D. Final Cover/Topsoil to be: r\ 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: "-'U U Date: <br />MPCA Certification No.: J S 22— <br />Staff <br />Z <br />Staff Review: Approv Denial ) - <br />Reviewer: <br />Date:�/� <br />Reason for Denial: <br />