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lo <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: )cPrecast Concrete _ Other Manufacturer <br /> Tank Capacities: 1) 5--,F)gal. 2)/egy4 gal. 3)/1051. gal. <br /> B. Pump Station (if required Q . <br /> Pump make & model C — (attach pump curve & <br /> literature); system design requires gpm at /3 feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by installer r electrician <br /> other . Inside electrical work mus be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe --0,Rock bed dimensions /Z.) 'x•-•- <br /> Drop Boxes Sand bed dimensions 4/3 'x,/ <br /> Distribution Box Pressure Dist. Pipe Diam. ,/,°d_" <br /> Maniford Pipe Diam. ,I-- " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> Atrucked 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: 1C3 <br /> � � <br /> Date: /2'171.6"MPCA Certification No. 0-7...._,.? <br /> Staff Review: Approv. _ Denial <br /> Reviewer: /�,I_ �,, /14 i <br /> Date: .�� 7-SJ <br /> Reason for Denial: <br />