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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: x Precast Concrete Other Manufacturer <br /> Tank Capacities: 1)�c�� gal. 2)/�<s� gal 3)i'o d � gal <br /> B. Pump Station(if required) � �> <br /> Pump make&model C-���.- ��C _ `f �(-' • (attach pump curve& <br /> literature); system design requires � gpm at �-f� � feet of head. <br /> High water alarm make&model �7.,c �� + . 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 made on this application are complete,true and correct. <br /> Signature ofApplicant��,,��J.`{-�=e'�y�.~-"". Date: �^ �� � �� -� <br /> MPCA License No. � / � <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> � <br /> StaffReview: Approval �� Denial <br /> � <br /> Reviewer: ��- �— Date• � � �� -D� <br /> Reason for Denial: <br />