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. <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 installin the following: <br /> A Tanks: Precast Concrete Other Manufacturer <br /> ,�'�r wi J� <br /> Tank Capacities: 1) o!� al. 2) /3ot� gal 3) ot� al <br /> B. Pump Station(if requued) <br /> Pump make&model ���L <� � �� y (attach pump cur�e& <br /> literature); system design requires 7 gpm at / 7 feet of head. <br /> High water alazm make&model .G.,c . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: • <br /> Trenches: s.f. J Mound <br /> Depth of rock below pipe " Rock bed dimensions�' x 6 z' <br /> Drop Boxes Sand bed d'unensions�' x 8�_' <br /> Distribution Box Pressure Dist. Pipe Diam. �'/z '� <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 stat ents ade on this application are complete,true and correct. <br /> Signature ofApplicant Date: G�—/ 3`� 3 <br /> MPCA License No. � <br /> Staff Review: Approval \ Denial <br /> Reviewer: " 1`'�Q'� Date: � (�—�� -'U� <br /> Reason for Denial: <br />