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NOTE: Appli(.alit must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxes. <br />/f A,)— 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: &4e—� SA. Tanks: (( Precast ConLrete Other Manufacturer YZ' <br />Tank Capacities: 1) 1 '-W dal. 2) (acv gal. 3)1 3w gal. <br />B. Pr_mp Station (if required) <br />Pump make & model M -,r" h4::5 qO (attach pump curve & <br />literature); system design 4quires '% ct_ gpm at I X— feet of head. <br />High water alarm make & model AA YG -s — Outside <br />electrical work to bP 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 />k Mound <br />Rock bed dimensions (t'x a ' <br />Sand bed dimensions 4 <br />Pressure Dist. Pipe Diam. t yL " <br />Manifc Npe Diam. -L- " <br />:owefj from site <br />,:ow location on site plan) <br />u ucked in <br />The unders:aned hereby applies to the City of Orono for issuance of a septic system insWlation <br />permit, agrees to do all work in strict accordance with the ordinances of the Cit;. aad the <br />regulations of the State of Minnesota, and certifies that all statements made on this application <br />are complete, true and correct. <br />SignatureofApplic% pijo OC Date: toZ'?-) <br />MPCA Certification No.: <br />Staff Review: Approval Denial <br />Reviewer: Date: <br />Reason for Denial: <br />