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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appr-cpriate <br /> boxes. <br /> r <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: —,!2,_ Concrete Other Manufacturer <br /> Tank Capacities: 1) OQ6 al. 2) /A-50 gal 3) / al <br /> B. Pump Station(if required) <br /> Pump make&model 4D U LD (attach pump cu e& <br /> literature); system design requires gpm at_ feet of head. <br /> High water alarm make&model k,! VL-7- L O tside <br /> electrical work to be completed by installer electrician :)ther. <br /> C. Treatment System: v <br /> Trenches: s.f. /� Mound <br /> Depth of rock below pipe Rock bed dimensions x a' <br /> Drop Boxes Sand bed dimensionsx ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. <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 ofa 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 cc ffect. <br /> =2 7 <br /> Signature of Applicant ,t Date: -/j' d2 <br /> MPCA License No. 39F <br /> ----------------------------------------------------------------------------------------------------------------- ------ <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />