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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 AAM w ; v- <br />Tank Capacities: 1) 12 So gal. 2) /:a gal. 3) gal. <br />B. Pump Station (if required) <br />Pump make & model (attach pump curve & <br />literature); system design requires gpm at feet of head. <br />High water alarm make & model 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 of Rock bed dimensions I'x,&L' <br />Drop Boxes Sand bed dimensions 9_q_'x Sl ' <br />Distribution Box Pressure Dist. Pipe Diam. . r, <br />Maniford Pipe Diam. <br />D. Final Cover/Topsoil to be: 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. <br />SignatureofApplicant: — % - Date: I <br />MPCA Certification No.: / ? as <br />Staff Review: Approv -�7'1—" al <br />Reviewer: Date; <br />Reason for Denial: <br />