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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxe�s.(j <br />s� r 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: Z Precast Concrete _ Other Manufacturer Je <br />Tank Capacities: 1) Kxoo gal. 2) /ovco gal. 3) oco gal. <br />B. Pump Station (if required) <br />Pump make & model R. Y, P ',., ),A (attach pump curve & <br />literature); system design requires Zc;, gpm at /(0_ feet of head. <br />High water alarm make & model ay - / . 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. X Mound ,? <br />Depth of rock below pipe Rock bed dimensions 'x 4W <br />Drop Boxes Sand bed dimensions t'xi1 ' <br />Distribution Box Pressure Dist. Pipe Diam. l i z " <br />Maniford Pipe Diam. A " <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 co t. <br />SignammofApplicant Date: <br />MPCA Cen )n No.: cJ 3. - 398 Cs,4/ 0 <br />Staff Review: : �pprov, <br />