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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)/e . " gal. 2) /,,,c7 C, gal 3) la<o gal <br /> B. Pump Station (if required) <br /> Pump make& model Gcw (.01`-52 (attach pump curve& <br /> literature); system design requires Lk, gpm at j c feet of head. <br /> High water alarm make & model ' 'l e 4, r- . Outside <br /> electrical work to be completed by installer X electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. )( Mound <br /> Depth of rock below pipe " Rock bed dimensions/O ' x 5 5--' <br /> Drop Boxes Sand bed dimensions /$ ' x 73_ ' <br /> Distribution Box Pressure Dist. Pipe Diam. Q. " <br /> Manifold Pipe Diam. 2— " <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 statementsatmade on this application are complete,true and correct. <br /> Signature of Applican 7�✓ Date: 25r--(::' <br /> MPCA License No. 2(, <br /> Staff Review: Approval y Denial <br /> �'' � C <br /> Reviewer: "l/l/- Date: �,5 -o <br /> Reason for Denial: <br />