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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> � r Septic <br /> I have received a copy of the system design including the City of Orono no <br /> System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: /Precast Concrete Other Manufacturer.D 4 Yu. <br /> Tank Capacities: 1)/out, gal. 2) /,'. p gal 3) /obi) gal <br /> B. Pump Station(if required) <br /> Pump make&model (oad fie-S-( (attach pump curve& <br /> literature); system design requires 3 8' gpm at Z© 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/0 ' x Sa ' <br /> Drop Boxes Sand bed dimensions7o ' x1/0 ' <br /> Distribution Box Pressure Dist. Pipe Diam. /�L " " <br /> Manifold Pipe Diam. v " <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 of Applicant ) 5 Date: y' --d <br /> Sr— <br /> MPCA License No. <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />