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ti <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 /> 2. I will be installing the following: ���-w�1�► <br /> A. Tanks: '� Precast Concrete Other Manufacturer �rcc�s�` <br /> Tank Capacities: 1) / �� al. 2) t 3 �� gal 3) ► 3 uv gal <br /> B. Pump Sta.tion(if required) <br /> Pump make&model Jtite��-s �t E `�v (attach pump curve& <br /> literature); system desi�requires �/� gpm at /S' feet of head. <br /> High water alarm make&model �;-�G�:. . 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 /U ' x�' <br /> Drop Boxes Sand bed d'unensions�' x��' <br /> Distribution Box Pressure Dist. Pipe Diam. I`�Z " <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 U���-� I` v�"- Date: 9'2-6 " GY� <br /> MPCA License No. �-� <br /> Stat�'Review: Approval Denial <br /> t ��� <br /> Reviewer: Date• < '�6 <br /> Reason for Denial: <br />