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• <br /> l <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> v 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) j&or gal. 2) gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model u l� (attach pump curve & <br /> literature); system design requires zieU gpm at :LS feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by installer electrician X <br /> other ©wA1, . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. ) Mound <br /> Depth of rock below pipe " Rock bed dimensions /o <br /> Drop Boxes ,Sand bed dimensions �l 'x Zt <br /> Distribution Box Pressure Dist. Pipe Diam. 2 " <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 co t. <br /> Signature ofApplicant: III �� j_ Date: 9 — 7� � <br /> MPCA Certification No.: (K) <br /> Staff Review: Approval Denial c� <br /> Reviewer: /./�i� 1- s///.�i <br /> / / <br /> 1 Date: <br /> Reason for Denial: <br />