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� � , . <br /> 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 includin� the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I�vill be installing the following: <br /> A. Tanks: �_Precast Concrete Other Manufacturer �,�L�✓sc� <br /> Tank Capacities: 1) ;;� �al. 2) �5 0� �al 3) � �____=�-�gal <br /> B. Pump Station (if required) <br /> Pump make& model �C� (attach pump curve& <br /> literature); system desi�n requires �/� gpm at feet of head. <br /> High water alarm make & model S"�h���'�� �c s. . Outside <br /> electrical work to be completed by installer�celectrician other. <br /> C. Treatment System: <br /> Trenches: s.£ �_ Mound <br /> Depth of rock below pipe iZ �� " Rock bed dimensions :�'D ' x G Z ' <br /> Drop Boxes Sand bed dimensions �l5'"' x °�' <br /> Distribution Box Pressure Dist. Pipe Diam. Z " " <br /> Manifold Pipe Diam. Z'` " <br /> D. Final Cover/Topsoil to be: �_ borro�ved 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 rejulations of the State <br /> of Minnesota,and certifies that all statements made on this application are complete,true and correct. <br /> 1 <br /> SignatureofApplicant � �'�'� Date: �U-��'"�s� <br /> MPCA License No. �� �� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staf�"Revie�v: Approval Denial <br /> Reviewer: �/l�./ ` ��� Date: � � � l l �� <br /> Reason for Denial: <br />