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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxes. <br />I have received a copy of the system design inchMing the City of Orono <br />Septic System Approval Cover Sheet. <br />2. I will be installing the following: <br />A. Tanks: � Precast Concrete _Other Manufacturer -r-1- \ 0 -QV -Qt <br />Tank Capacities: 1) Sa gal. 2) &!22 gal. 3) - .—S�al. <br />B. Pump Station (if requireid <br />Pump make & model Zoe 04— (attach pump curve & <br />literature); system design requires A(—)__ gpm at l2 feet of head. <br />High water alarm make & model 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. <br />Depth of rock below pipe <br />Drop Boxes <br />Distribution Box <br />4- Mound <br />Rock bed dimensions LO 'x&S <br />Sand bed dimensions I't 'x�' <br />Pressure Dist. Pipe Diam. <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 statemf 's made on this application <br />are complete, true <br />SignatureofAppli Date:" --I — u <br />MPCA Certification No.: ( LC") <br />Staff Review: Approv Denial s� <br />Reviewer: Date- <br />Reason <br />ateReason for Denial: <br />