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_ , ' . <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> v 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 install�the following: � <br /> A Tanks: �� Precast Concrete Other Manufacturer Q�i�Gt�Lii(� <br /> TankCapacities: 1) 13Ga �al. 2)�3p-o gal 3) gal <br /> B. Pump Station(if required) <br /> Pump make&model (attach pump curve& <br /> literature); system design requires �� gpm at�_feet of head. <br /> High water alazm make&model �i��t�'LT� . Outside <br /> electrical work to be completed by installer electrician other. <br /> � <br /> C. Treatment System: <br /> � � Trenches: !� D s.f. Mound <br /> Depth of rock below pipe�" Rock bed dimensions ' x ' <br /> ✓ Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold 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 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 th 11 statements made on this application aze complete,true and conect. <br /> SignatureofApplicant ` � ` Date: � � <br /> MPCA License No. �-- �S� <br /> Staff Review: Approval Deniat <br /> Reviewer: Date• <br /> Reason for Denial: <br />