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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 installin a following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1)Aim) gal. 2) laze gal 3) /a,, v gal <br /> B. Pump Station(if required) <br /> Pump make&model (attach pump curve& <br /> literature); system design requires gpm at 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 ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. <br /> Manifold Pipe Diam. <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 Date: A -3., —a 3 <br /> MPCA License No. /9. /S/G <br /> Staff Review: Approval Denial <br /> Reviewer: o ‘frrre � -e 14L7 �1 / f Date: q Z /3 <br /> Reason for Denial: <br /> i DA) /6iu G J ( 4- - /2. ?per, t�� - t+3 cc a- /1 -c-p <br /> ce,upt L't� 1�'i L/ti€ PAX l Atr ige>0 4 S 14/1A�U% I 4 P a'T <br /> Gor+1P/ t roap i/1 G iti'4--raU 0P- ..0,1a.vei' c,& <br /> (664.1,up ti.D.res 6'Jose 7a e?.e rek �� 1-1"- -). <br /> /v 5�77� �,���1-/oN <br />