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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> r <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 instal�ing the following: <br /> A. Tanks: � Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) %,!"'��Q gal. 2) j��C%D gal 3) .i i.-'_:��� gal <br /> B. Pump Station(if required) <br /> Pump make&model r�I �< < �) (attach pump curve& <br /> literature); system design requires �'7 gpm at /�- feet of head. <br /> High water alarm make& model ���t.�� �, ;-t t � +i�' r���� . 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 l��' ' x '�Z' ' <br /> Drop Boxes Sand bed dimensions�' x Y�',�� ' <br /> Distribution Box Pressure Dist. Pipe Diam. -�'� " <br /> Manifold Pipe Diam. ,�S '' " <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 ofa 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 st�tements made on this application are complete,true and correct. <br /> __� . <br /> Signature ofApplicant � _�• ��(�,c��%� ,�_, -�z �_ Date: --� ` � ��'� <br /> MPCA License No. -�`-''�� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> StaffRevie�v: Approval Denial <br /> Reviewer: ��� �'��"2-�'�� �L }_.---_ Date: � 1 i C � <br /> Reason for Denial: <br />