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r � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> G�,���U 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: �3 Precast Concrete Other Manufacturer <br /> TankCapacities: 1) � � gal. 2) /j�� �al 3) ( � gal <br /> B. Pump Station(if required) <br /> Pump make& model lM� �-' (attach pump curve& <br /> literature); system design requires Z gpm at � � feet of head. <br /> High water alarm make& model �,-v-�tti:_ . Outside <br /> electrical work to be completed by�installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. � l�found <br /> Depth of rock below pipe " Rock bed dimensions �d ' x �� 5 ' <br /> Drop Boxes Sand bed dimensions�2 ' x io.s' <br /> Distribution Box Pressure Dist. Pipe Diam. ( �z " <br /> Manifold Pipe Diam. Z " <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 work in strict accordance with ordinances of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> SignatureofApplicant ��������^- Date: I ) ^ � �3 � � ( <br /> ��� L�n���� <br /> MPCA License No. <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval /'\ Denial <br /> Reviewer: ��4`�l� GL�'v�'""��K—� Date: 11 - �3 - 01 <br /> Reason for Denial: <br />