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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> ` <br /> P <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: —Precast Concrete Other Manufacturer �fF✓wr h <br /> Tank Capacities: 1)_ZoGe gal. 2) CQpo gal 3) gal <br /> B. Pump Station(if required) � n � ' � <br /> Pump make&model L( P f� �� f (attach pump curve& <br /> literature); system design requires -3 S gpm at feet of head. <br /> High water alarm make&model kyLw- Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. G,--- Mound <br /> Depth of rock below pipe Rock bed dimensions 10 'x <br /> Drop Boxes Sand bed dimensionsx�' <br /> Distribution Box Pressure Dist. Pipe Diam. J`z- <br /> Manifold Pipe Diam. 2- <br /> D. <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 Qrono 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: <br /> MPCA License No. 6O r L-; <br /> Staff Review: Approval X Denial <br /> Reviewer: G, ax- Date: <br /> v <br /> Reason for Denial: - <br /> ,� o, S <br />