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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 including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> �5'� 2. I will be installing the following: <br /> A. Tanks: �_Precast Concrete Other Manufacturer Pf c C�s'f <br /> Tank Capacities: 1) ooa al. 2) �oa o gal 3) /�a� gal <br /> B. Pump Sta.tion(if requued <br /> Pump make&model ���� (attach pump curve& <br /> literature); system design requires 3 / gpm at ! � feet of head. <br /> High water alarm make&model An �,(o..r, . 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 �d ' x 4� ' <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 statements made on this application are complete,true and conect. <br /> P{fi��se,� e.o. c� �,/� <br /> SignatureofApplicant ,� ' Date: r �"'7 ' � O <br /> MPCA License No. ,� 1 I <br /> Staff Revie�v: Ap oval Denial <br /> . <br /> Reviewer: Date: q— l�� flC7 <br /> ---r <br /> Reason for Denial: �—' <br />