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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 /> Ye" S 2. I will be installing the following: <br /> / A. Tanks: 3 Precast Concrete Other Manufacturer oae«c%‘ <br /> Tank Capacities: 1) (cw gal. 2) ("61-() gal. 3) I uy gal. <br /> B. Pump Station (if required) <br /> Pump make & model PK lz/L' (attach pump curve & <br /> literature); system design requires °7 o gpm at ZO..> feet of head. <br /> High water alarm make & model 6--c-vac,,-t_ 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 /> 3 Trenches: 3 ( s.f. Mound <br /> Depth of rock below pipe i " Rock bed dimensions 'x ' <br /> 3 Drop Boxes Sand bed dimensions 'x <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Maniford Pipe Diam. <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 ofApplicant: CJ Date:: < 2-° <br /> MPCA Certification No.: <br /> Staff Review: Appro al Denial <br /> Reviewer: . /A# / Z --' Date: <br /> Reason for Denial: <br />