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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxes. <br />ye 1. I have received a copy of the system design including the City of Orono <br />T� Septic System Approval Cover Sheet. <br />2. I will be installing the following: <br />A. Tanks: X Precast Concrete <br />Tank Capacities: 1)EZrf , gal <br />_ Other Manufacturer Qrecat <br />2) (51c(, gal. 3) iW_ gal. <br />B. Pump Station (if required) <br />Pump make & model k1C 5^ M Y«s (attach pump eurve & <br />literature); system design requires yam_ gpm at 5 ,6 feet of head. <br />High water alarm make & model Outside <br />electrical work to be completed by )< installer electrician K <br />other Inside electrical work must be completed by <br />elec-.rician. <br />C. Treatment System: <br />3 Trenches: qw s.f. Mound <br />Depth of rock below pipe Rock bed dimensions •x ' <br />-3 Drop Boxes Sand bed dimensions 'x ' <br />Distribution Box Pressure Dist. Pipe Diam. " <br />Maniford Pipe Diam. " <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 />Signature ofAppl icant: i "'o 0,Q" Date: <br />MPCA Certification No.: 8 Sro <br />y-.2 8-- r 7 <br />Staff Review: :;i <br />Denial <br />Reviewer: / Date:;g: <br />Reason for Denial: <br />