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NOTE: Applicant must initial all spaces. Fill i.n 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) /ZSO gal. 2) i2so gal. 3) gal. <br /> B. Pump Station (if required) . (,,,�;�� ry,�,� ��,,��;� <br /> Pump make & model za��/�� �/.37 (attrch pump curve & � <br /> literature); system design requires �_ gpm at �(� fe o���ead. <br /> �ii�:, water alarm make �, ;nod�1 �,1 E/ac�ra %y�_l�• u�st�e <br /> electrical work to be completed by installer �! electrician ��,r�,E,��� <br /> other Inside electrical work must be completed by <br /> electrician. <br /> � �Qe� a�A,�,G,...cG e�`�� C. Treatment System: <br /> ���ro��� ��� ���es�a Trenches: s.f. � Mound <br /> � � ' , Depth of rock below pipe " Rock bed dimensions ��'x�' <br /> �h�k �p ;s poss�,��. Drop Boxes Sand bed dimensions �_'x �'y '-da�;es Sa� <br /> SL 1so �o M ��,J�ron^�w��'�'�``�' Distribution Box Pressure Dist. Pipe Diam. �.� " �����s <br /> A � ��a A�a� . Maniford Pipe Diam. �_ <br /> �.1e �w^ ��� S <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 c�rect. / / / <br /> �h ,S AD �d e 1�Gi6CG�J a'FlcJ9.�✓C , <br /> SignatureofApplicant: 1� v0 Date: � <br /> MPCA Certification No.: a3(o� <br /> , <br /> Staff Review: Approv � Denial <br /> Reviewer: ate• � �' <br /> Reason for Denial: <br />