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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 instal ' g the following: <br /> c <br /> A Tanks: Precast Concrete Other Manufacturej4�4aA <br /> Tank Capacities: 1) /3U gal. 2)l.7 Qal 3) 7p gal <br /> B. Pump Station(if required) <br /> Pump make&model (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make&model Outside <br /> electrical work to be completed by nstaller electrician other. <br /> C. Treatment System; <br /> Trenches: -s.f. L/ Mound <br /> Depth of rock below pipe Rock bed dimensions 0 ' x ' <br /> Drop Boxes Sand bed dimensions�U' x <br /> Distribution Box Pressure Dist. Pipe Diam. ("2 " <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 tha statements ade on this application are complete,true and correct. <br /> Signature ofApplicant ` Date: <br /> MPCA Li se No. <br /> -------__-------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />