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� <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 installing the following: <br /> A Tanks: �C Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) l3ad �aL 2) l 30o g� 3� �3 ao �� <br /> B. Pump Station(if required) <br /> Pump make&model �E'OS (attach pump curve& <br /> literature); system design require; y�.lo gpm at I 8 .9 feet of head. <br /> High water alarm make&model . Outside <br /> electrical work to be completed b�- installer X electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensions /b ' x �'3 ' <br /> Drop Boxes Sand bed d'unensions'1'1•�'' x 87 ' <br /> Distribution Box Pressure Dist. Pipe Diam. � " <br /> Manifold Pipe Diam. oZ " <br /> D. Final Cover/Topsoil to be: x bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Orono for��uance 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 1 stat ts made on this application aze complete,true and conect. <br /> SignatureofApplicant Date: ��~��y <br /> MPCA License No. +� 3�� <br /> StaffReview: Approval Denial <br /> Reviewer: Date• <br /> Reason for DeniaL• <br />