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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 /> I/ 2. I will be installing the following: , l-� <br /> A. Tanks: 41 Precast Concrete Other ManufacturerlPif W, <br /> Tank Capacities: 1)/te0 dal. 2) 'oct7 gal 3) /0c'O gal <br /> B. Pump Station(if required) <br /> Pump make&model® A4 TL'A (attach pump curve& <br /> requires literature); system desig equires yo gpm at /s feet of head. <br /> High water alarm make&model `400.1 . 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 /y ' x ' ' <br /> "Drop Boxes • 'Sand bed dimensions ? ' x 77 Vir3 <br /> Distribution Box Pressure Dist. Pipe Diam. .. " <br /> Manifold Pipe Diam. zi " <br /> D. Final Cover/Topsoil to be: X borrowed from site MeleowA,e,e/Raix . <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City ofQrono 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 of Applicant ,e9 Date: l v4Lt•�/ <br /> MPCA License No. /(0L <br /> Staff Review: Approval X Denial <br /> Reviewer: "}' Kbt( Date: 1 n - 30 -01 <br /> Reason for Denial: <br />