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r <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <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: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 16co gal. 2) i ocr gal 3) /6cr a gal <br /> B. Pump Station(if required) <br /> Pump make& model Guy, (j. (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make&model �n c o T . . Outside <br /> electrical work to be completed by installer_ k electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. 39�X ? S Mound <br /> Depth of rock below pipe Rock bed dimensions i o ' x L/ <br /> Drop Boxes Sand bed dimensions S ' x ?5r,' <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 /> 11( 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-j��� � '-"`,-� Date: <br /> MPCA License No.—2-I ct <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval f' Denial <br /> u <br /> Reviewer: ^ -_ Date: �- 1 <br /> Reason for Denial: <br />