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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxes. <br />1. 1 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 t Other Manufacturer L, . <br />Tank Capacities: I } 1 r gal. 2) gal. 3) gal. <br />i . - <br />B. Pump Station (if required) <br />Pump make & model ro�ji t~,Ee6v, rl (attach pump curve & <br />literature); system design requires gpm at ' feet of head. <br />High water alarm make & model . Outside <br />electrical work to N. completed by installer electricaa 1 <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 ' <br />Drop Boxes Sand bed dimensions 'x ' <br />Distribution Box Pressure Dist. Pipe Diam. <br />Maniford Pipe Diam. " <br />D. Final Cover/Topsoil to be: t 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 />Signature of Appl icant: <br />MPCA Certification No.:" - `l <br />Date: o <br />Staff Review: Apo al Denial <br />Reviewer: � Doe: <br />Reason for Denial: <br />/k . '_ <br />