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sox <br /> 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: cast Concrete Other Manufacturer .4111' �^ <br /> Tank Capacities: 1)_,ZDyD gal. 2) edal 3)%y4-.;, gal <br /> B. Pump Station(if required) _ <br /> Pump make& model �t S Cl.,14,ko (attach pump curve& <br /> literature); system design requires Lf O gpm at -2-1 feet of head. <br /> High water alarm make&model „P(Q -t-- . Outside <br /> electrical work to be completed by installer c/electrician other. <br /> C. Treatment System: ,�. <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe Rock bed dimensions l0 ' x S5' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. 1 Yz- " <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 stateme made on this application are complete,true and correct. <br /> Signature of Applicant �S Date: <br /> MPCA License No. �C) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Staff Review: Approval >< Denial <br /> Reviewer: (! V ` Date: 1 — —U <br /> Reason for Denial: <br />