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NOTE: Applicant must initial all spaces. Fill in all appropriate bla.nks 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: �`�{```�s�' <br /> A Tanks: r� Precast Concrete Other Manufacturer ��'��'`"~ <br /> Tank Capacities: 1) lS�c� gal. 2) �S`uo gal 3) /� �al <br /> B. Pump Sta.tion(if required) <br /> Pump make&model -Z m-e I�,c�- (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water ala.rm make&model �c S'T �l,��,�,..l,�f . 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�o ' x 7S ' <br /> Drop Boxes Sand bed d'unensions°q'_�' x so ' <br /> Distribution Box Pressure Dist. Pipe Diam. 7 " <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 /> The 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 /> SignatureofApplicant Date: 7 �Z Z '�`� <br /> MPCA License No. � � � <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Staff Review: Ap oval Deni <br /> Reviewer: � Date• / Z—�D� <br /> Reason for Denial: <br /> N �� �.�� d � s,�� ,_ <br />