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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 />v 2. I will be installer -the following: <br />A. Tanks: i/ Precast Concrete _ Other Manufacturer ALL.' S <br />Tank Capacities: 1) gal. 2) 4cw4, gal. 3) /Z,so gal. <br />B. Pump Station (if required) 4/e'd IN — 2-tv u�iTs- <br />Pump make & model 6;vL, Wc, 3W S (attach pump curve & <br />literature); system design requires -T�o gpm at ,7 9 feet of head. <br />High water alarm make & model &o..,Ko,k Outside <br />electrical work to be completed by installer electrician I,,"" <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 L'x 6Y ' <br />Drop Boxes Sand bed dimem.-inns ,W xM <br />Distribution Box Pressure Dist. Pipe Diam. <br />Maniford Pipe Diam. �_ = 3 r <br />D. Final Cover/Topsoil to be: borrowed from site <br />ow 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 />SignatureofApplicant:, *�-- -- --- --Date: kZ 3 `! <br />MPCA Certification No.: S <br />Staff Review: Approval Denial Q/ <br />Reviewer: Date: C�r-jr- / 6 <br />Reston for Denial: <br />