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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 />QQ Septic System Approval Cover Sheet. <br />2. I will be installing the following: <br />A. Tanks: ). Precast Concrete _ Other Manufacturer <br />Tank Capacities: 1) 13w gal. 2) r vn gal. 3) 13CLD gal. <br />B. Pump Station (if required) <br />Pump make & model -AA 6 q0 (attach pump curve & <br />literature); system design requires 3m at feet of head. <br />High water alarm make & model Wilt Outside <br />electrical work to be completed by installer electrician 1_ <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 ' <br />_ Drop Boxes Sand bed dimensions 1*2- ' 4 <br />xE:' <br />Distribution Box Pressure Dist. Pipe Diam. I�It <br />Maniford Pipe Diam. 2 " <br />D. Final Cover/Topsoil to be: _X 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 />permi!, 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 />SignatureofApplicantA"XV Date: g' 'Z l- q <br />MPCA Certification No.: If 7 Z <br />Staff Review: Approval Denial <br />Reviewer: Date:-Z-2)--2S-7— <br />Reason <br />ate: ' 2)—� <br />Reason for Denial: <br />