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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 Or <br />Septic System Approval Cover Sheet. <br />2. I will be tailing the following: <br />A. Tanks Precast Concrete _Other Manufacturer <br />Tank Capacities: 1)12-50 gal. 2) (pro gal. 3) (ZSo gal. <br />B. Pump Station (if required <br />Pump make & model S �r - 'Uff- Su% (attach pump curve & <br />literature); system design requires _ qQ_ gpm at Z'� `eet of head. <br />High water alarm make & model .� &-;Z 'f • • 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. zl Mound <br />Depth of rock below pipe Rock bed dimensions -&-'xG' <br />Drop Boxes Sand bed dimensions 5- <br />Distribution Box Pre :sure Dist. Pipe Diam. ` <br />Maniford Pipe Diam. Z. <br />D. Final Cover/Topsoil to be: —Y— 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 ork in strict accordance with the ordinances of the City and the <br />regulations of the State Minnesota, and, certifies that all statements made on this application <br />are complete, true and c •ect <br />SignatureofApplicant: Date: <br />MPCA Certification No.: a <br />Staff Review: Approval Denial <br />Reviewer: pl �---� Date: <br />Reason for Denial:_ <br />