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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�llEC�+S� <br /> Tank Capacities: 1) ( �'j gal. 2) `" �j gal 3)�_gal <br /> B. Pump Station (if required) ��'-� <br /> Pump make&model (-'�z.� ' j (attach pump curve& <br /> literature); system design requires �11 gpm at_ �� feet of head. <br /> High water alarm make& model - _ ?►�iYi� A(����, 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 I� ' x ��' <br /> Drop Boxes Sand bed dimensions�' x��' <br /> Distribution Box Pressure Dist. Pipe Diam. ('�2 " <br /> Manifold Pipe Diam. 2" " <br /> D. Final Cover/Topsoil to be: � borrowed from site ��vc,�F,zcxv� t.{-ou� <br /> (show location on site plan) E�cc�tv��t-�o,v �p�.x� <br /> trucked in 'T� n�lo�,�:p S�?� <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 th tements made on this application are complete,true and correct. <br /> SignatureofApplicant � Date: 7- � •-O� <br /> MPCA License Na �� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval \/ � enial <br /> Reviewer: ��:� � �L�—c,� Date: � ``��J C� � <br /> Reason for Denial: <br />