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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 _ Other Manufacturer <br />Tank Capacities: 1) LLtL gal. 2) gal. 3) Zf,20 gal. <br />B. Pump Station (if required) <br />Pump make & model 62dd wed S:/1 (attach pump curve & <br />literature); system design requires 36 gpm at 31, feet of head. <br />High water alarm make & model ' 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. Mound <br />Depth of rock below pipe Rock bed dimensions /'x ci' <br />Drop Boxes Sand bed dimensions -V_'xA_' <br />Distribution Box Pressure Dist. Pipe Diam. ys " <br />Maniford Pipe Diam. -_" <br />D. Final Cover/Topsoil to borrowed from site— sh t kP dg <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 a)1 statements made on this application <br />are complete, true and correct. 14 <br />SignatureofApplicant: <br />MPCA Certification No.: <br />Staff Review: Appr Val �' Denial <br />Reviewer: — Date:--ZA—� <br />Reason for Dt--su.!: <br />