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y <br /> 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: y�`/ <br /> A. Tanks: X Precast Concrete Other Manufacturer lel/e /"leis k`e <br /> Tank Capacities: 1) gal. 2) gal 3) IfC)C' gal <br /> B. Pump Station(if required) <br /> Pump make&model ZoC/ler (attach pump curve& <br /> literature); system design requires m at feet of head. <br /> High water alarm make &model LeverTed col_ . Outside <br /> electrical work to be completed by installer , electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions l() ' x 0 ' <br /> Drop Boxes Sand bed dimensions 3g-' x7-1,' <br /> Distribution Box Pressure Dist. Pipe Diam. y " <br /> Manifold Pipe Diam. D-- " <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 .`4/ Date: /U —/7 j-1 <br /> MPCA License No. D ^ <br /> Staff Review: Approval Denial <br /> Reviewer: ,,1�' Date: 1 0 = 20 —0y4A.) - C9 <br /> Reason for Denial: <br />