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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: x Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 13Uo gal. 2) 1 3 ccs gal 3) ?cam gal <br /> B. Pump Station(if required) <br /> Pump make& model M '!�- L/O (attach pump curve& <br /> literature); system design requires gpm at 17 feet of head. <br /> High water alarm make& model Outside <br /> electrical work to be completed by installer _electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe Rock bed dimensions/U ' x ?�' <br /> Drop Boxes Sand bed dimensions x TO T' <br /> Distribution Box Pressure Dist. Pipe Diam. 1 `/i " <br /> Manifold Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: X 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 (LIIIW 2 Date: -7 Z 3 <br /> MPCA License No. <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval ')� Denial <br /> Reviewer.• Date: 7"a3-O <br /> Reason for Denial: <br />