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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) i,S�� �al. 2) 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. Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' x ' <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 m e on this application are complete,true and correct. <br /> Signature ofApplicant Date: ' � - �v' � <br /> MPCA License No. � ��C'J <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval �� Denial <br /> Reviewer: �" 0`\� �1��� �2�'7 -c,�Y— Date: � (���U a C� � <br /> Reason for Denial: <br /> � U w c�e� r�.v S�— cj e-r p v MP-���� _���t e e,.�e�c S:�j �e c� <br /> �•- �k�.,:� � t`�� n�L, , <br />