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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: CZ Precast Concrete _ Other Manufacturer <br />Tank Capacities. 1) gal. 2)1c(_,c) gal. 3) iccc, gal. <br />B. Pump Station (if required) <br />Pump make & model C ck, 0(attach pump curve & <br />literatureN; system design requires - l gpm at / k- feet of head. <br />High water alarm make & model L t- v, Outside <br />• ' electrical work to be completed by _ Y installer electrician <br />other Inside electrical work must be completed by <br />electrician. <br />C. Treatment System: <br />Trenches: s. f. <br />Depth of rock below pipe <br />Drop Boxes <br />Distribution Box <br />Mound <br />Rock bed dimensions /v 'x .S S <br />Sand bed dimensions �'x !K�f71 <br />Pressure Dist. Pipe Diam. i ' Z " <br />Maniford Pipe Dian. -J- " <br />D. Final Cover/Topsoil to be: borrowed from site <br />(show location on site plan) <br />�X 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 />SigmtumofApplicant: _NLIDate: <br />MPCA Certification No.: 19,;z <br />Staff Review: Approval Denial n <br />Reviewer: Date: <br />Ream for Denial: <br />