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I <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 Tanks: ,3 Precast Concrete Other Nlanufacturer <br /> Tank Capacities: 1)-�,�� gal. 2) /o�✓� gal 3)�g� <br /> /�� <br /> B. Pump Station(if requued) <br /> Pump make&model �DU,(�D (attach pump curve& <br /> literature); system design requires�gpm at �/ feet of head. <br /> High water alazm make&model ,(�1/� A-LR-R� . Outside <br /> electrical work to be completed by insta.11er X electrician other. <br /> C. Treatment System: <br /> �Trenches: /o�Ol� s.f. Mound <br /> Depth of rock below pipe /oZ " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Nianifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby appties 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 /> SignatureofApplic�nt � � ,Lu�c ' ��-��- ��- Date: /l�/� `�.3 <br /> MPCA License No. �9� <br /> Staff Review: Approval Denial <br /> Reviewer: Date• � <br /> Reason for Denial: <br />