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%N <br />NO plicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />bo <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 i% Other Manufacturer <br />Tank Capacities: 1) y ; gal. 2) gal. gal. <br />B. Pump Station (if required <br />Pump make & model, (attachpump 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 _L:::� installer a ectrician <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 /e, 'x;Q�' <br />Drop Boxes Sand bed dimensionsr -'x 17 <br />Distribution Box Pressure Dist. Pipe Diam. <br />Maniford Pipe Diam. „1 <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 />SignatureofApplicany �Date: f <br />MPCA Certification No.: <br />Staff Review: Approval Denial <br />Reviewer: 9`7 1O <br />Reason for Denial: <br />