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NOTE: Applicant must i.nitial 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 <br /> Tank Capacities: 1) ./O��gal. 2) �4�a1 3) �al <br /> B. Pump Station(if required) <br /> Pump make&model AY lYIC,'�ONH'(-D (atta.ch pump curve& <br /> literature); system design requires � pm at �o feet of head. <br /> High water alarm make& model �v� �+���'`� . 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 Q' x -�' <br /> Drop Boxes Sand bed dimensions�' x 4l ' <br /> . Distribution Box Pressure Dist. Pipe Diam. 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 Qrono for issuance of a septic system installation permit, <br /> agrees to do all work in strict accordance with ordinanc of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements made t 's application are complete,true and correct. <br /> Signature ofApplicant Date: ����� �� <br /> MPCA License No. ��0 <br /> . � . . <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> StaffReview: Approval Denial <br /> Reviewer: Date• <br /> Reason for Denial: <br />