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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 Systear Approval Cover Sheet. <br />2. 1 will be install' the following: <br />A. Tanks: ✓ Concrete _ Other Manufacturer <br />Tank Capacities. 1) gal. 2) gal. 3) gal. <br />B. Pump Station (if ired) <br />Pump make & mod (attach pump curve & <br />literature); system d requires gpm at feet of head. <br />H; .h water alarm & model Outside <br />electrical work to be co m leted by installer electrician <br />other ide 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 LQ_'r.�Z' <br />Drop Boxes Sand bed dimensions }k'x�' <br />Distribution Box Pressure Dist. Pipe Diam. I <br />-- �►�ianiford Pipe Diam. 2 <br />D. Final Cover/Topsoil to be: ✓ bo wed from site <br />( w location on site plan) <br />truck in <br />The undcrsigned hereby applies to the City of Oro for issuance or a on <br />permit, agrees to do all work in strict accorda with the ord%nances of the City and the <br />regulations of the State of Minnesota, and certifies that all statemet4s made on this application <br />are complete, true and correct. <br />SignatureofApplicant: - Date: ! x Y7 9 N <br />MPCA Certification No.: 13 A S <br />Staff Review: Approval Denial <br />Reviewer: <br />Reason for Denial: <br />Date: <br />