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r , <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 installing the following: <br /> r A. Tanks: L��+Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) �al 3) gal <br /> B. Pump Station(if required) <br /> Pump make&model �7: S�' (attach pump curve& <br /> literature); system design requires gpm at 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 1�' x�' <br /> Drop Boxes Sand bed dimensions /o x t/� <br /> Distribution Box Pressure Dist. Pipe Diam. � '�,Z " <br /> Manifold Pipe Diam. 3 '' " <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 Date: <br /> MPCA License No. <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval 7 Denial <br /> Reviewer: /t o1�Y•e.c, ���L,�r�'./ Date• 1 — � 3 `C� S <br /> Reason for Denial: <br />