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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 />2. I will be installing the following: <br />A. Tanks: 3 Precast Concrete _ Other Manufacturer pry c a,% 7 Sys7� <br />Tank Capacities: 1)16_ gal. 2) /0o- gal. 3) JJ& gal. <br />B. Pump Station (if required) <br />Pump make & model M Y v"s /W (attach pump curve & <br />literature); system design requires 3jD gpm at _1ff ' feet of head. <br />High water alarm make & model .&V . 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 />Mound <br />Rock bed dimensions -Le—'x <br />Sand bed dimensions' <br />'x <br />Pressure Dist. Pipe D'_" <br />Maniford Pipe Diam. A," <br />D. Final Cover/Topsoil to be: l- 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. '.qt� 'r L" <br />SignatureofApplicant: J� l rS�W P 1,^Zw <br />Date: <br />MPCA Certification No.: /0'2 a <br />Staff Review: A oval Denial <br />S PPr <br />Reviewer: Date -D27* <br />2Z* <br />Reason for Denial: <br />