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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> V1. I have received a copy of the system design including the City of Orono <br /> 9-0 Septic System Approval Cover Sheet. <br /> .2. I will be installing the following. <br /> Z. <br /> A. -Tanks: X Precast Concrete Other Manufacturer Dav-wu '\ <br /> Tank Capacities: 1) 1_?60 gal. 2) 17uu gal. 3) 12ug gal. <br /> B. Pump Station (if required) <br /> Pump make & model M,6 1�0 (attach pump curve & <br /> literature); system design requires <br /> R!2 gpm at feet of head. <br /> High water alarm make & model �, _ Outside <br /> • ' electrical work to be completed by installer electrician)C _ <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Y Mound <br /> Depth of rock below pipe " Rock bed dimensions ./D 'x 6 6 v <br /> Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. ,rL " <br /> Maniford Pipe Diam. Z 7y aZ <br /> 3� <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 /> SignatureofApplicant: Da D-- <br /> Date: � Z ff q 7 <br /> MPCA Certification No.: <br /> Staff Review: Approval Denial <br /> Reviewer: Date: o� <br /> Reason for Denial: <br />