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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal 3) gal <br /> B. Pump Station(if required) <br /> `T Pump make& model 6oL.0 'R-7 sj (attach pump curve & <br /> literature); system design requires_gpm at 7-,--1 feet of head. <br /> High water alarm make& model �5--SC' Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. _ Mound <br /> Depth of rock below pipe " Rock bed dimensions /0 ' x� ' <br /> Drop Boxes Sand bed dimensions -{7 ' x y3 '*,511 <br /> Distribution Box Pressure Dist. Pipe Diam. ✓ " <br /> Manifold 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 permit, <br /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature of Applicant Date: eI2�0 <br /> MPCA License No. L <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> Reviewer: �� Date: - 9 <br /> Reason for Denial: <br /> I <br />