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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check ali appropriate <br /> boxes. <br /> 1. I have received a copy of the system design including tbe City of Orono Septic <br /> �— System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: �Precast Concrete Other Manufacturer�// /G,K ;�/vc� � <br /> Tank Capacities: 1) laaa gal: 2) �pv� gal 3) �v�p gal �``�� <br /> � Cc�rr�J��tv��►'1�PF'� f�u"'�+fc�tc� <br /> B. Pump Station (if required <br /> Pump make& model vu�d 7°�'y/ __(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 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 Sv ' <br /> Drop Boxes Sand bed dimensions �1/ ' x��' <br /> Distribution Box Pressure Dist. Pipe Diam. 4� " <br /> Manifold Pipe Diam. ,� " <br /> D. Final Cover/Topsoil to be: borrowed 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{ '�[�/IGG� �Y�y��-� � Date: �' �'-0"7 <br /> MPCA License No. o�gc�� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> �_ <br /> Staff Review: Approval �'/ Denial <br /> � ���� � <br /> Reviewer: �,�/�� �,r �!�� Date: (� <br /> Reason for Denial: <br />