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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: 3 Precast Concrete _ Other ManufactureriFU//`,I,> <br />Tank Capacities:. 1) /odo gal. 2) Int-,_ gal. 3) -,au" gal. <br />B. Pump Station (if required) 0 Y^Y#e &AV <br />Pump make & model le5►a i &/= (attach pump curve & <br />literature); syst_m design requires R gpm at -Z,�) feet of head. <br />High water alarm make & model _ DU tr. 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. __ Mound <br />Depth of rock below pipe Rock bed dimensions /o 'x Sc-)' <br />Drop Boxes Sand bed dimensions S o 'x io ►' <br />-- Distribution Box Pressure Dist. Pipe Diam. Z " <br />Maniford Pipe Diam. _j�!A7" <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 />SignatureofApplicant: ACG %���1.lur Date: <br />MPCA Certification No.: # 9 <br />Staff Review: Approv Denial <br />Reviewer: <br />Reason for Denial: <br />