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� <br /> NOTE: Applicant must i.nitial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> _ 1. I have received a copy of the system design i.ncluding the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I�vill be installing the following: <br /> A Tanks: X Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) ,�gal. 2) /p p D gal 3)_ gal � <br /> B. Pump Station(if required) <br /> Pump make&model (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> Hi�h 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�_' x 5� ' <br /> Drop Boxes Sand bed dimensions 36 ' x�� ' <br /> Distribution Box Pressure Dist. Pipe Diam. a " <br /> Manifold Pipe Diam. a " <br /> D. Final Cover/Topsoil to be: bono�ved from site <br /> (show location on site plan) <br /> _� trucked in <br /> The undersigned hereby applies to the City of Orono for issuance ofa septic system installationpermit, <br /> a�rees 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 s tements made on this application are complete,true and conect. <br /> , <br /> SignatureofApplicant � Date: 7��4'�� <br /> NIPCA License No. �9� <br /> • • , <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Revie�y: Approval Denia] � <br /> Reviewer: �Ob� Date• ��3� -a I <br /> Reason for Denial: <br />