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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> /y11 <br /> A 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) /C;po gal. 2) lEx�o gal 3) 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 installer electrician other. <br /> C..Treatment System: <br /> Trenches: s.f. 11 Mound <br /> Depth of rock below pipe " Rock bed dimensions 10 ' x Sty <br /> Drop Boxes Sand bed dimensions Ix ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: ✓ borrowed from site <br /> ( n site p ) <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 ofApplicant Date: <br /> MPCA License No. <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> [� <br /> Reviewer: / (/`'✓lam([� Date: 4 � 2 q'07 <br /> Reason for Denial: <br />