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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: D( Precast Concrete Other Manufacturer <br /> Tank Capacities: 1)lcts0 o gal. 2)/gym gal 3)/ao d gal <br /> B. Pump Station(if required) <br /> Pump make& model (attach pump curve& <br /> literature); system design requires Y g gpm at . 7 feet of head. <br /> High water alarm make& model /24.c./.c._)-1 . Outside <br /> electrical work to be completed by installer k electrician other. <br /> C. Treatment System: \4___ <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " 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: `7 "- 2 LK' <br /> MPCA License No. 2 i 5 <br /> Staff Review: Approval Denial <br /> Reviewer: C\‘'NOctz ,11 ' Date: Lt.1-(6 <br /> Reason for Denial: <br />