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f , , <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> � �4 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 following: <br /> A. Tanks: ✓ Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) � ocu gal. 2) pt; gal 3) j3�, gal <br /> B. Pump Station (if required) <br /> Pump make& model �a��t c.Q ��o� (attach pump curve& <br /> literature); system design requires y y gpm at Z Z_ feet of head. <br /> High water alarm make& model �,,��c,f,.,., . 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�c� ' x 6 Z: <br /> Drop Boxes Sand bed dimensions�c�' x `3 Z ' Avz - <br /> Distribution Box Pressure Dist. Pipe Diam. j '�i " <br /> Manifold Pipe Diam. Z— " <br /> D. Final Cover/Topsoil to be: ✓borrowed from site f�����r"`�� <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 /> a�rees 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 application are complete,true and correct. <br /> Signature of Applicant �—' Date: �� � �� Z.- <br /> MPCA License No._ �D �Q <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval �\ Denial <br /> i <br /> Reviewer: " �'�C�� '?���--� Date• �1 � � —�� <br /> Reason for DeniaL• <br />