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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: _✓Precast Concrete <br />Tank Capacities: 1) 1pow gal <br />Calf <br />2) !a►d gal <br />Manufacturer <br />3) i•-v gal. <br />B. Pump Station (if required) <br />Pump make & model - 6J) AA0511 (attach pump curve & <br />literature); system design requires VV gpm at 1I? feet of head. <br />High water alarm make & model s S. Elgho 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. Mound <br />Depth of rock below pipe ock bed dimensions ,�' x Ste' <br />Drop Boxes Sand bed dimensions 31__' x !/ ' <br />Distribution Box Pressure Dist. Pipe Diam. ja:" <br />Maniford Pipe Diam. z- " <br />D. Final Cover/Topsoil to be: borrowed from site <br />(show location on site plan) <br />X*L- 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 ordinar_ces 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: e-g�Date: - L Y- it <br />MPCA Certification No.: g� <br />Staff Review: App a ual <br />Reviewer: -�> - - ." - <br />Date: <br />- <br />Reason for Denial: <br />