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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> Xe 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 C P' aL 2) /S '- gal 3) gal <br /> B. Pump Station(if required) <br /> Pump make&model v!�S (attach pump curve& <br /> literature); system design requires('7 4,5" gpm at f 10 - feet of head. <br /> High water alarm make&model . Outside <br /> electrical work to be completed by installer K. electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensions(a ' x/- Q ' <br /> Drop Boxes Sand bed dimensions 6/ ' x /(a ' <br /> Distribution Box Pressure Dist. Pipe Diam. 2` " <br /> Manifold Pipe Diam. 2-u <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> U� 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 -74Date: "?.-c <br /> MPCA License No. Z/ <br /> Staff Review: Approval Denial <br /> Reviewer: 4 1Date: - -OLS <br /> Reason for Denial: <br />