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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 installi following: <br /> A. Tanks Precast Concrete Other Manufacturer�•4�wi fr, <br /> Tank Capacities: 1) (65+.1, ie al. 2)ec,�;7 �O``'gal h400, 3) /0 00 gal <br /> B. Pump Station (if required) <br /> Pump make&model 600/, ,e4/// (attach pump curve& <br /> literature); system design requires •Z-6., gpm at /y feet of head. <br /> High water alarm make & model /, (0-4, . Outside <br /> electrical work to be completed by installer 1lectrician other. <br /> C. Treatment System: <br /> Trenches: s.f. ' Mound <br /> Depth of rock below pipe " Rock bed dimensions/D ' x ' <br /> Drop Boxes Sand bed dimensionsS ' x e/Z <br /> Distribution Box Pressure Dist. Pipe Diam. /i2 " <br /> Manifold Pipe Diam. 2— <br /> D. <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> /(show location on site plan) <br /> t/ 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 of Applicant2 // Date: p z 0 <br /> MPCA License No. lP((v <br /> Staff Review: Approval )( Denial <br /> Reviewer: Q) Date: -- 'O� <br /> Reason for Denial: <br />