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� 1 � <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: _Precast Concrete Other Manufacturer Prec 4 Sy s411S <br /> Tank Capacities: 1) 1pOp gal. 2) Bodo gal 3) loop gal <br /> B. Pump Station (if required) <br /> Pump make&model I/?— (`� ld� _(attach pump curve& <br /> literature); system design requires___3 t gpm at 19 feet of head. <br /> High water alarm make & model Outside <br /> electrical work to be completed by installer electrician C other. <br /> C. Treatment System: <br /> Trenches: s.f. _ Mound <br /> Depth of rock below pipe_ f Rock bed dimensions 10 ' x-_' <br /> Drop Boxes Sand bed dimensions -4 ' x��' <br /> Distribution Box Pressure Dist. Pipe Diam. Z " <br /> Manifold Pipe Diam. 1 I12 " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> X 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 statements made on this application are complete,true and correct. <br /> Signature of Applicant , Date: <br /> MPCA License No. 2-42A <br /> ---------------------------------------------------------- -------------------------------- ----------------------------- <br /> Staff Review: Approval Denial <br /> —��-� <br /> Reviewer: log ett Ik Date: � <br /> Reason for Denial: <br />