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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 /> 2. I will be installin_ • . 1: V ��s ,'c'9' '� <br /> A. Tanks: - 'recast Cone "to _ Other Manufacturer <br /> Tank Capaci - . gal. 2) /4:7O7gal. 3) gal. <br /> B. Pump Station (if require <br /> Pump make & model v/d (attach pump curve & <br /> literature); system design requires 45/7 gpm at/ " Z feet of head. <br /> High water alarm make & model Li ( 11-44�. Outside <br /> electrical work to be completed by installer N. 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 /0 'x (o Z' <br /> Drop Boxes Sand bed dimensions&+/ 'x <br /> Distribution Box Pressure Dist. Pipe Diam. Z. " <br /> Maniford Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: X 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: 9 <br /> v 6-,-1-...,,a--0Date: B -//-etc, <br /> MPCA Certification No.: 3vvgii C <br /> Staff Review: A ovalDenial <br /> Reviewer: Date: <br /> Reason for Denial: <br />