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� i ' <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 desijn including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be installin?the followin�: U S�e � x �` S��'�� 'ru��/<S � ,�_ o/< <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal 3) gal <br /> B. Pump Station(if required) n j <br /> Pump make& model Q o� /d S � ���� (attach pump curve & <br /> literature); system design requires �F gpm at l� feet of head. <br /> High water alarm make & model kJr �� � � . 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� 2 ' <br /> Drop Boxes Sand bed d'unensions ��' x/a 2. ' <br /> Distribution Box Pressure Dist. Pipe Diam. �" " <br /> Manifold Pipe Diam. 2 " " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (sho�v location on site plan) <br /> `� _ trucked in <br /> The undersi?ned hereby applies to the City of Orono for issuance ofa 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 Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> SignatureofApplicant j Date: �'� b � � o � <br /> �� / �� `� � � � !`�on L`O <br /> MPCA License I�To. '``�r � � <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> Staff Revie���: Approval X Denial <br /> Reviewer: ����- ��?`�T�'�z;-,-. ����;� Date: �--l._ r� _ �� , <br /> Reason for Denial: <br />