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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxes. <br />I. I have received a copy of ;h.- system design including the City of Orono <br />Septic System Approval Cover Sheet. <br />� _ 2. I will be installing the following: <br />A. Tanks: v- Precast Concrete _ Other Manufacturer _1?i. ��. �✓ <br />Tank Capacities: 1) Z � gal. 2) gal. 3) _ gal. <br />B. Pump Station (if required) � �✓ '�5%F <br />Pump make & model L, ,- i<<' !wL o ii (attach pump curve & <br />literature); system design requires J!V gpm at _Z feet of head. <br />High water alarm make & model _ �,�r•�.... 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. k.-' Mound <br />Depth of rock below pipe Rock bed dimensions [o'x i z ' <br />Drop Boxes Sand bed dimensions&_'x ' <br />Distribution Box Pressure Dist. Pipe Diam. r •%& " <br />Maniford Pipe Diam. 2- " <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 issuac- 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: 4/,, �'- Z <br />601 <br />MPCA Certification No.: C <br />Staff Review: Approial Denial <br />Reviewer: Date: <br />Reason fn..denial: <br />