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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> J 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> (Ef 2. I will be installing the following: <br /> A. Tanks: >' Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) /00t gal. 2) Oe.)6 gal 3) (GfaG gal <br /> B. Pump Station (if required) <br /> Pump make& model et/r,', F 3?25 (attach pump curve& <br /> literature); system design requires 5-/ gpm at '3 S— feet of head. <br /> High water alarm make & model Ai( SL co h l-', . 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 /U ' x 68' <br /> Drop Boxes Sand bed dimensions'/ ' <br /> Distribution Box Pressure Dist. Pipe Diam. z " " <br /> Manifold Pipe Diam. Z `' <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 of Applicant Date: //' <br /> MPCA License No. / Z a <br /> Staff Review: Approval Denial <br /> Reviewer: q11e Date: " i S-0 1 <br /> Reason for Denial: <br />