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r► t <br /> 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 installing the following: <br /> A. Tanks: >< Precast Concrete Other Manufacturer <br /> Tank Capacities: 1)/c'Z.t gal. 2) /l:, gal. 3),'- gal. <br /> B. Pump Station (if required) <br /> Pump make & model (att ch ump curve & <br /> literature); system design requires "1/4-cg gpm at if feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by in alley electrician <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Ro k bed dimensions /25 'x • 0 <br /> Drop Boxes Sand bed dimensions c x 7r'} <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 /> /V 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. -1 / <br /> Imo.,,/ � �,� <br /> Signature of Applicant: '�� LG' ' Date: ' <br /> MPCA Certification No / <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />