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. <br /> 4 <br /> 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 '��ias�g th�ollowing: <br /> � <br /> A Tanks: �-i Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) t�al. �) gal 3) gal � <br /> B. Pump Station(if required) <br /> Pump make&model (atta.ch pump curve& <br /> literature); system design requires - gpm at feet of head. <br /> High wa.ter 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 Dis� 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 sta ements ade on this application are complete,tsue and conect. <br /> Signature ofApplicant Date: �Z-o ► <br /> MPCA License No. � �v <br /> Stat�'Review: Approval Denial <br /> Reviewer: ��� Date•� �—�~ � y <br /> Reason for Denial: <br />