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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> '1 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 4 2. I will be installing the following: <br /> A. Tanks: 1.------Precast Concrete Other Manufacturer -4ra.1 s) <br /> r-epJ Tank Capacities: 1) WV gal. 2) /009 gal 3) .gal <br /> l s' vJ Z� <br /> B. Pump Station(if required) <br /> Pump make&model (attach pump curve& <br /> uCt literature); system design requires gpm at feet of head. <br /> jtoks") High water alarm make&model . 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 ' x <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. <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 stat ents mad on this application are complete,true and correct. <br /> Signature of Applicant Date: �� o,6 <br /> MPCA License No. ll/ L/ <br /> Staff Review: Approval V Denial <br /> pp <br /> Reviewer: Date: —1 1 0 G <br /> Reason for Denial: <br />