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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> - Y;:>__L- <br /> 1. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> c'-' ' 4P— <br /> .2. I will be installing the following: <br /> A. Tanks: ,/ Precast Concrete _ Other Manufacturer Dczrw,1 <br /> 1 <br /> Tank Capacities: 1) /dO)U gaI. 2) 7 7j gal. 3)/( 90 gal. <br /> B. Pump Station (if required) <br /> Pump make & model (V&e),$// 60 v/t (attach pump curve & <br /> literature); system design requires 3 Fs gpm at Z-o feet of head. <br /> High water alarm make & model L2oe lap Outside <br /> electrical work to be completed by installer lectrician <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. c/ Mound <br /> Depth of rock below pipe " Rock bed dimensions /O 'x SO ' <br /> Drop Boxes Sand bed dimensions 80 'x 35 ' <br /> Distribution Box Pressure Dist. Pipe Diam. 7z" " <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. <br /> SignatureofApplicant: • <br /> Date: f_9_ �S"-- <br /> MPCA Certification No.: ' 9O <br /> Staff Review: Apprr . / <br /> Denial <br /> Reviewer: /i'��� ,\ i Date: / �Q <br /> Reason for Denial: <br />