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NOTE: Applicant must initial aIl 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: x Precast Concrete Other Manufacturer owN l,�J;��crt <br /> Tank Capacities: 1) �000 Qal. 2) 150o gal 3) �000 gal <br /> �p 1�.s yy�,�tt;-�10� U�.v►�+ <br /> B. Pump Station(if requued) <br /> Pump make&model ��\� 1�-3� (attach pump curve& <br /> literature); system design requires 35 gpm at 7 feet of head. <br /> High water alazm make&model �'aw,� A.1ert . Outside <br /> electrical work to be completed by installer_ � electrician other. <br /> P„�mp �2 Zc�/t-�' B/u r�JC .�?y'�;c.r.� 33 c��� <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe la " Rock bed dimensions �a ' x a 5 ' /F�oos�F� <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. a" " <br /> Manifold Pipe Diam. a" " <br /> D. Final Cover/Topsoil to be: bonowed 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 th all s tements made on this a plication are complete,true and correct. <br /> SignatureofApplicant � Date: /�-/7- v3 <br /> MPCA License No.__ � �'�l D <br /> Staff Review: Approval � Denial <br /> Reviewer: !1�'� ��� �G �`�--�_ Date• �C' '�'�'��"� <br /> Reason for Deniat: <br /> � ��j fi (z_ i-:�r �. ��.���� t� �'��'����3'=-�� ��Z r --,�' ��Fc� t '��� c <br /> , �I� ,�-,-v� <br />