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_ � j � <br /> . <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 /> A. Ta.nks: Precast Concrete Other Manufacturer,���./l� <br /> Tank Capacities: 1) �3� gal. 2) /' Cra gal 3) gal <br /> B. Pump Station (if required) <br /> Pump make& model_�c�,E'�,.� (attach pump curve& <br /> literature); system.design requires�gpm at �3c� feet of head. <br /> High water alarm make & model "��� ��-C�'�T . Outside <br /> electrical work to be completed by�installer�electrician other. <br /> �- <br /> C. Treatment System: <br /> Trenches: s.f. ou d' <br /> Depth of rock below pipe " Rock bed imensions lL-� ' x�' <br /> Drop Boxes Sand bed dimensions�' x��' <br /> Distribution Box Pressure Dist. Pipe Diam. f•s�s�-L�P.� <br /> Manifold Pipe Diam. a" " <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 /> 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 tha all statements made on this application are complete,true and conect. <br /> G <br /> Signature of Applicant ` v�-�--- Date: �� d� <br /> MPCA License No. � �� � <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Staff Review: Approval � Denial <br /> Reviewer: �GC� -�,.r---- Date• �Cf- � - �� <br /> Reason for Denial: <br />