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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> 4 )Ve-S 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 — Other 0uManufacturer l�/�as�-OAl'wL)et <br /> Tank Capacities: 1) -w° gal. 2) ►'kkiI gal. 3) (SW gal. <br /> B. Pump Station (if required) <br /> Pump make & model M C 410 yer- (attach pump curve & <br /> literature); system design requires i gpm at 13 feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by installer electrician x <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. ?C Mound <br /> Depth of rock below pipe Rock bed dimensions RD 'x <br /> Drop Boxes Sand bed dimensions 'x 2 i ' <br /> Distribution Box Pressure Dist. Pipe Diam. R <br /> Maniford Pipe Diam. 2 " <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 of Applicant: AV Date: ) - 2 S� <br /> MPCA Certification No.: / S-7 _ <br /> Staff Review: Approval `,_ Denial <br /> #411,Reviewer: , /j' ;ice/e/ Date: <br /> Reason for Denial: <br />