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� - . . , <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> bo <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 : ��1�5��� - n` �' ''� Zoo3 <br /> . g g U� � <br /> A Tanks: �ecast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal 3) gal <br /> B. Pump Station(if required) <br /> Pump make&model v.,� (attach pump curve& <br /> literature); system design requires � C� gpm at /3 feet of head. <br /> High water alarm make&model��/��L„r . Outside <br /> electrical work to be completed by �%�ristaller electrician other. <br /> C. Trea ent Sy . <br /> Tr ches: s.f. � Mound <br /> Dep rock below pipe " Rock bed dimension�0 ' x 63 ' <br /> Drop oxes Sand bed dimensions�' x 7�' <br /> Distribution Box Pressure Dist. Pipe Diam. Z— " <br /> Manifold Pipe Diam. Z ° <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 /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota.,a.nd certifies that all statements made on this application are complete,true and correct. <br /> Signature ofApplicant 'e S Date: � �r� <br /> MPCA License No. � `C�J <br /> -------------------------------------------------- --------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> Reviewer: /�5�11� Date•(�' 1 U 'U� <br /> Reason for DeniaL• <br />