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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 Manufacturer <br /> Tank Capacities: 1) l000 gal. 2) l000 gal 3) I000 gal <br /> B. Pump Station(if required) <br /> Pump make&model Gold's llz V%P (attach pump curve& <br /> literature); system design requires 31 gpm at tG' feet of head. <br /> High water alarm make &model . Outside <br /> electrical work to be completed by installer electrician X other. <br /> C. Treatment System: <br /> Trenches: 51 Y Mound <br /> Depth of rock below pipe Rock bed dimensions 10 ' x -41 ' <br /> Drop Boxes Sand bed dimensions 4 1—? x ni <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 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 ApplicantDate: to-Zq-O"7 <br /> MPCA License No. 24 2-A <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> VX <br /> Staff Review: Approval Denial <br /> Reviewer: `/ Cx��� Date: <br /> Reason for Denial: <br />