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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) 1���� gal. 2) �oU�j gal 3) gal <br /> B. Pump Station (if required) <br /> Pump make&model (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make& model . Outside <br /> electrical work to be completed by insta.11er electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensionsl U ' x �O ' <br /> Drop Boxes Sand bed di.mensions `-}1 ' 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 applica � n aze complete,true and correct. <br /> / / ��.5�-�� <br /> SignatureofApplicant<� Date: <br /> ' � G <br /> MPCA License No. �/ � <br /> Staff Review: Approval � Denial <br /> � -S- C> <br /> Reviewer: "�'1� �-ci-,� Date• , <br /> Reason for Denial: <br /> � 5<'e. lo�(�-�:o�; L> �1 �l' 4 �` ��`��\ <br />