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• ,, <br /> , . .►�,..,r,,,. , • <br /> , <br /> r . , , <br /> • <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 insta.11ing the following: <br /> A Tanks: �_Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 150� gal. 2) ►SO� �al 3) ga1 <br /> B. Pump Staxion(if required) <br /> Pump make&model (attach pump curve& <br /> literature); system,design requires gpm at feet of head. <br /> High water alazm make&model . 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 ' 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: 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,and certifies that all statements made on this application are complete,true and correct. <br /> Signature ofApplicant�,� ��...,. � Date: q �t �y �p7 <br /> MPCA License No. � Z`�Z-¢ <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval i� Denial <br /> Reviewer: �� Date• �'��— a � <br /> Reason for Denial: � <br /> .�,< Mql� S J t c k`at �<,��.5 �< < L c�e o r v S�. <br /> ��.,,,,. ��.�\LS� <br />