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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 /> � .--._� <br /> �J 2. I will be installin the following: . <br /> A Tanks: �recast Concrete Other Manufacturer ���`�'`^ <br /> Tank Capacities: 1) O00 al. 2) /�v gal 3)�gal <br /> B. Pump Station(if required) r� PC�� <br /> Pump make&model �v (attach pump curve& <br /> literature); system design requires 3� gpm at�_feet of head. <br /> High water alarm make&model 5.� . 2�•���> . 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 SO ' <br /> Drop Boxes Sand bed dimensions 70 ' x 3 9 ' <br /> Distribution Box Pressure Dist. Pipe Diam. '�-- ° <br /> Manifold Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: bonowed 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 stax ents made on this application aze complete,true and correct. <br /> SignatureofApplicant � - Date: �"� �''� <br /> MPCA License Na (2�� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Staff Review: Approval Denial <br /> Reviewer: �jtJ � Date• � � f ���� <br /> Reason for Denial: ' <br />