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. � <br /> ! . <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> � <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 installi g the following: <br /> A. Tanks: C�Precast Concrete Other Manufacturer [=��L�S <br /> Tank Capacities: 1) /h S c:� gal. 2) �, c� gal 3) (ZSG gal <br /> B. Pump Station (if required) <br /> Pump make& model ��,,�,L✓� S (attach pump curve & <br /> literature); system design requires �S'. � gpm at "ZS. `� feet of head. <br /> High water alarm make & model A,�c tF�e �_ � ,,,_,��_;%,•� . 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 lo ' x 75(' <br /> Drop Boxes Sand bed dimensions,/�_�' x,�' /.30�c �C� <br /> Distribution Box Pressure Dist. Pipe Diam. �Z " " <br /> Manifold Pipe Diam.� � � " <br /> � � �— <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 /> 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 statem, ts made on this application are complete,true and correct. <br /> , <br /> Signature ofApplicant , ' � � Date: �� J �S <br /> MPCA License No. � �S � <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Rei�ie�v: Approval _ Denial <br /> Reviewer: Date• <br /> Reason for Denial: <br />