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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> r <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 install'}ng the following: <br /> A. Tanks:�Precast Concrete Other Manufacturer�,�2�Ur� 1��eti�,'�j <br /> Tank Capacities: 1) /,���X> gal. 2) �/. ,�>r� gal 3) �� gal <br /> B. Pump Station(if required) <br /> Pump make& model G,r���(�� ,��=�,% (attach pump curve& <br /> literature); system design requires �� gpm at_ Z,� feet of head.� <br /> High water ala.rm make&model ,P,�a�,��� . Outside <br /> electrical work to be completed by installer �c electrician other. <br /> C. Treatment System: �n' � �,� � <br /> Trenches: s.f. !► L' Mound <br /> Depth of rock below pipe " Rock bed dimensions /n ' x �c4' ' <br /> Drop Boxes Sand bed dimensions D ' x�,�'1c1;2' ' <br /> Distribution Box Pressure Dist. Pipe Diam. �, " <br /> Manifold Pipe Diam. ��i " <br /> �/.�z;` 36`' o,c., <br /> D. Final Cover/Topsoil to be: �_ borrowed from site <br /> (show location on site plan)��"'"` ��''�"�"'� <br /> X 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 work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota.,and certifie t at all statements made on this application are complete,true and correct. <br /> Signature of Applicant � Date:_ ��%���� <br /> MPCA License No. ,f 7 z� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> StaffReview: Approval Denial <br /> Reviewer: ��,� `'�J�-�� Date: ��Z-�='�� <br /> Reason for Denial: <br /> � .�ve G�.ri c,-c, �3e L�J'i ni�- ..d e� �i TF�" h��e.e � ,�'cT SITG' .-c'�,('r�: dD �v,c. [<°.�'l <br />