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v� <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 design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> "�� <br /> 2. I will be installin following: <br /> A Tanks: Precast Concrete Other Manufacturer�� <br /> Tank Capacities: 1),%;��'v gal. 2)foc�; gal 3)l���� gal <br /> B. Pump Station(if required) � <br /> Pump make&model�o��t� L�a� �z �"�'` (atta.ch pump curve& <br /> literature); system design requires c� u gpm at � 2 feet of head. <br /> High water alarm make&model ��\��„„� . 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��' x S�_ ' <br /> Drop Boxes Sand bed dimensions��' x��' <br /> Distribution Box Pressure Dist. Pipe Diam. / '% " <br /> Manifold Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: Y 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 statements made on this application are complete,true and conect. <br /> SignatureofApplicant - �---s Date: � � -.�? � � ���--- <br /> MPCA License No. � � � <br /> . <br /> Staf�'Review: Approval Denial <br /> Reviewer: " �`��-. " P���-c,.`^ � Date: S� �� }` � � <br /> Reason for Denial: <br />