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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. 1 will be installing the following: t,a�W� <br />A. Tanks: _ recast Concrete _ Other Manufacturer <br />Tank Capacities: 1) 13vo gal. 2) Ill gal. 3) jjgj)._ gal. <br />B. Pump Station (if required) C��e� <br />Pump make & model !. "Ji (attach pump curve & <br />literature); system design requires Aq gpm at I— feet of head. <br />Hish water alarm make & model AjkAc eim% 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: r� <br />Trenches: s. f.Mound <br />Depth of rock below pipe Rock bed dimensions 1J 'xjze' <br />Drop Boxes Sand bed d mensioas3L_'xL' <br />Distribution Box Pressure Dist. Pipe Diam. its " <br />Maniford Pipe Diam. <br />D. Final Cover/Topsoil to be: borrowed from site <br />(show location on site plan) <br />WAS" - - ked 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:` 91 4a�,ss-� Date: (i-22-5 a __ <br />MPCA Certification No.: <br />Staff Review: Approval Z�;- Denial <br />Reviewer: MIR <br />Reason for Denial: <br />