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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> bo s. <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 e following: <br /> A. Tanks: � Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) oU gal. 2) ov gal 3)4- gal <br /> B. Pump Station (if requirg.4i) �� ��l <br /> Pump make&modeller (attach pump curve& <br /> literature); system design requires_ppm at feet of head. <br /> High water alarm make& model ST Q4v,,.,b-5 . Outside <br /> electrical work to be completed by installer t.� electrician other. <br /> C. Treatme t Syste : / <br /> renc es: s.f. y Mound <br /> Depth o ro below pipe " Rock bed dimensions /D ' x 6 3 ' <br /> op Boxes Sand bed dimensions-/7 ' x C 7 <br /> Distribution Box Pressure Dist. Pipe Diam. //�'z " <br /> Manifold Pipe Diam. Z " <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 /> �SDate: <br /> Signature of Applicant <br /> MPCA License No. y <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval_ Denial <br /> Reviewer: ���G - Date: <br /> Reason for Denial: <br />