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� <br /> NOTE: Applicant must uutial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> �f 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) ��gal. 2) /S'oa gal 3) /,roa gal <br /> B. Pump Sta.tion(if required) <br /> Pump make&model z ��� (attach pump curve& <br /> literature); system design requires .� gpm at�feet of head. <br /> High water alarm make&model �'y',vc�e+e_ ��r�Fl� . Outside <br /> electrical work to be completed by ' installer � electrician other. <br /> C. Treatment System: <br /> _�Trenches: !(�(o 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: _� borrowed from site ��'�b5 <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 pemut, <br /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> ofMinnesota,and certifies that all staxements made on this applica.tion are complete,true and conect. <br /> SignatureofApplicant Date:� �.� 43� <br /> MPCA License No. o�yf� . <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Staff Review: Approval .� Denial <br /> Reviewer• ��/��'�x+ Q� Date• (s ` �� '�� <br /> Reason for Denial: <br />