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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: Precast Concrete Other Manufacturer <br /> \ \ Tank Capacities: 1) gal. 2) gal 3) gal <br /> Add I (600��( ;7 (w,-57,-n'Z f-t«S o<< .7 j3da ,Q, <br /> B. ump Station(if required) <br /> Pump m odel --curve& <br /> literature); system desig gpm at feet of head. <br /> High wt <br /> e&model Outside <br /> ical work to be completed by installer elec other. <br /> • C. Treatment System: 101�a K;s7m� K Trenches:,2 29 $Tt- Mound <br /> Depth of rock below pipe /2 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: 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 Applicant Date. <br /> MPCA License No. 1, <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />