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f <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 desi�n including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I�vill be instali ng the following: <br /> A. Tanks: � .-, P er cast Concrete Other Manufacturer �C.� �S <br /> Tank Capacities: 1) /,�,�; gal. 2) IC�U gal 3) 2''C) gal <br /> B. Pump Station(if required) p (�,1�?L�,.�1 ( ff <br /> Pump make& model�;Ut,1�c� �� �=%�J�� �(attach pump curve& <br /> liieia�ure j; sysiem design requires t' gpm at�feet of head. <br /> High water alarm make & model — � G 1 c�i-P//�/7jv�0utside <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 /G� ' x�� <br /> Drop Boxes Sand bed dimensions��' x�'�- <br /> Distribution Box Pressure Dist. Pipe Diam.� �_��� " <br /> Manifold Pipe Diam. j %� " <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 �vork in strict accordance with ordinances of the City and the regulations of the State <br /> of 1�Iinnesota,and certifies that all ta ments made on this application are complete,true and correct. <br /> y ` ) , �j �)C.�� �� <br /> SignatureofApplicant � _ Date: ! � `/ ' <br /> MPCA License No. ;� ��� � <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> � <br /> Reviewer: �&�� �,��%-'� Date: � /�1�,�'i� <br /> Reason for Denial: <br />