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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 /> 2. I will be installing the following: ,� ��,s, <br /> f1. Tanks: ��Precast Concrete ! �tf Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal 3) gal <br /> B. Pump Station (if required) <br /> Pump make& model__���-��_ (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> Hi�h water alarm make&model . Outside <br /> electrical work to be completed by installer electrician other. <br /> Z,� <br /> C. Treatment System: yh�,���ri►- <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: �_ bonowed 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 /> ajrees 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 ofApplicant '�� �' � �v� � Date: l�-�� <br /> � <br /> MPCA License No. 2�,3'� <br /> Staff Revie�v: Approval Denial <br /> Reviewer: J <br /> � Q�Y. 2�zL,--� Date: ` b - ` -- (;�� <br /> Reason for Denial: <br />