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� <br /> / y <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 /> 2. I will be installing the following: <br /> A Tanks: �Precast Concrete Other Manufacturer ��'LL�' ��,A-�N� <br /> Tank Capacities: 1)_��al. 2)1/,,�j(� gal 3) f D�(� gal �LoC�L <br /> B. Pump Station(if requued) <br /> Pump make&model (attach pump curve& <br /> literature); system design requires ��. .gpm at ,,�D feet of head. <br /> High water alarm make&model I�1,/V�'1. Y�-Lt�i2►'tti . Outside <br /> electrical work to be completed by installer�electricia.n other. <br /> C. Treatment System: �/ <br /> Trenches: s.f. /\ Mound <br /> Depth of rock below pipe " Rock bed dimensions�' x 7� <br /> Drop Boxes Sand bed d'unensions��l,7' x 97� ' <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 /> X 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 s ements made on this application are complete,true and correct. <br /> Signature ofApplicant � � ��f��� Date: 0 �' �v�_ <br /> MPCA License No. �9� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> Reviewer: Date• <br /> Reason for Denial: <br />