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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 /> 2. I will be installing the following: /� <br /> A. Tanks: �Precast Concrete Other Manufacturer�r r`�"5� <br /> Tank Capacities: l�gal. 2)la`�a gal 3) faa� gal <br /> �a� <br /> B. Pump Station (if required) (� � <br /> Pump make &model CC3v �d�J` (attach pump curve& <br /> literature); system design requires ` �17 gpm at J���feet of head. <br /> High water alarm make& model ����6 � - . Outside <br /> electrical work to be completed by installer�electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. Mound /1.'� �0 3 <br /> Depth of rock below pipe " Rock bed dimensions.��' x-� ' <br /> Drop Boxes Sand bed dunensions�' x.��/� <br /> Distribution Box Pressure Dist. Pipe Diam. e2rt " <br /> Manifold Pipe Diam. 2 " <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 /> 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 correct. <br /> Signature of Applicant `�""'O— �""� Date: �` � � �- o '� _ <br /> MPCA License No. o� � ` <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval � V eni 1 <br /> Reviewer: � Date: C�'��S-`C�� <br /> �1��r�t <br /> Reason for Denial: ��7 p�� )Z� �S L.,J'cZ�� J� ��.`S.'5-�-�.��02 d 17/l�T <br />