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. 4 <br /> N, <br /> ,- <br /> NOTE: <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 /> Tanks: x Precast Concrete _ Other Manufacturer <br /> . Capacities: 1)/ gal. 2) ;•fi gal. 3)//>cegal. <br /> B. Pump tation (if required) <br /> Pump m: e & model :.e) `./ _ 0 f (attach pump curve & <br /> literature); , stem design , I wires If gpm at y feet of head. <br /> High water . arm m. - & model , 9!,,,- 7,___A . Outside <br /> electrical work t. be ' •mpleted by installer electrician ,K <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. TreatmerSystem: <br /> )( renches: s.f. Mound <br /> De' ii of rock below pipe /v.— Rock bed dimensions /0 'x fO' <br /> Drop Boxes nd bed dimensions go '3(...19 ' <br /> Distribution Box Pressure Dist. Pipe Diam. / .." <br /> Manid Pipe Diam. " <br /> D. Final Cover/Topsoil to be: A( borrowed m site c <br /> (show location on site plan) <br /> K. 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 /> Signature of Applicant:/1 - i', . ' �-. Date: /% -)7--- 57 <br /> MPCA Certification Nb.: oF/3 ' <br /> Staff Review: Approval Denial <br /> Reviewer: <br /> lyri_____, / ;ate: /��P <br /> Reason for Denial: <br />