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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 installi�the following: /�, � <br /> A. Tanks: Y Precast Concrete Other Manufacturer/7���'�"SrSyS��S <br /> Tank Capacities: 1) �G'gal. 2)�gal 3)_�G gal <br /> B. Pump Station (if required) <br /> Pump make & model � p '�t � (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make&model n;�- � Sc rt,' � �Outside <br /> electrical work to be completed by installer electrician'` other. <br /> _�-- <br /> C. Treatment System: <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions 10 ' x �.S' <br /> Drop Boxes Sand bed dimensions �S ' x 3�' <br /> Distribution Box Pressure Dist. Pipe Diam. I %z' " <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 /> a�rees to do all �vork in strict accordance with ordinances of the City and the regulations of the State <br /> of l�linnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Si�nature ofApplicant Date: �� �� r � � <br /> MPCA License No. �3�v <br /> -------------------------------------------------------------------------------------------------------------------------� <br /> Staff Revie�ti•: Approval � Denial <br /> Reviewer: '�1�`- � _ Date: � � — � 6" � � <br /> Reason for Denial: <br />