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r.+. . <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 installin�the followin�: <br /> A. Tanks: Precast Concrete �Other Manufaciurer �`''�v`'�5�� <br /> Tank Capacities: 1) I p0� jal. 2) l�d �al 3) ��O jal <br /> B. Pump Station (if required) <br /> Pump make& model ��r�v�-� ��— y 1 (attach pump curve& <br /> literature); system desijn requires "ZU gpm at '_�(_feet of head. <br /> Hi�h water alarin make &model i_�'tl��.���1/� . Outside <br /> electrical work to be completed by installer�_electrician other. <br /> C. Treatment System: <br /> �_Trenches: '��7 s.f. Mound <br /> Depth of rock below pipeCu,ny,� ' �j Rock bed dimensions ' x ' <br /> �� Drop Boxes Sand bed dimensions ' 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 Ciry of Orono for issuance of a septic system installation permit, <br /> ajrees to do all work in strict accordance with ordinances of the City and the rejulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature ofApplicant,�� (�,e ,,,,��� ,�.� Date: (( � P���ro <br /> MPCA License No. �. '?(�-��c' <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staf#'l�ev�e�v: Approval � I)eni�� <br /> Reviewer: �.!/��•�C�-x+ �<���r'C� D�te• �� " ��- j>� <br /> �easoa� for �enia➢: <br />