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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. Ta.nks: �Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) o o al. 2) f �o al 3)lmoo � �al <br /> B. Pump Station(if require� <br /> Pump make&model c U s� , (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make&model . Outside <br /> electrical work to be completed by insta.11er r� electrician other. <br /> C. Treatment System: , <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions/� ' x�2. ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. 2. " <br /> Manifold Pipe Diam. 2 " <br /> D. Final Cover/Topsoil to be: bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> Th�undersigned hereby applies to the City of Orono for issuance ofa 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 conect. <br /> Signature ofApplican�;��� . Date:� �� �"� �^ <br /> MPCA License No. 2��'/ <br /> Staff Review: Approval Denial <br /> Reviewer: �' �� \�� Date• �-����� <br /> Reason for Denial: <br />