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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: 'S <br /> A. Tanks: V-Precast Concrete Other Manufacturer 7' <br /> Tank Capacities: 1) (ZS 0 gal. 2) 1 ZS o gal 3) gal <br /> B. Pump Station(if required) w, <br /> Pump make&model e k t'5 (attach pump curve & <br /> literature); system design requires G 2- gpm at 3/ 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. �� Mound - nJ <br /> Depth of rock below pipe " Rock bed dimensions /d ' x3Z ' <br /> Drop Boxes Sand bed dimensions 1-E0 ' xL+7 ' <br /> Distribution Box Pressure Dist. Pipe Diam. 11/Z- <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 a 1 statements ade on this application are complete,true and correct. <br /> Signature of Applicant ' Date: 47 <br /> MPCA License No. <br /> Staff Review: Approval X Denial <br /> Reviewer: u l 1 Date: I I- b - o <br /> Reason for Denial: <br />