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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br />boxes. <br />R1. I have received a copy of the system design including the City of Orono <br />nn Septic System Approval Cover Sheet. <br />ILU 2. 1 will be installing the following: <br />A. Tanks: )( Precast Concrete _ Other Manufactt rer <br />Tank Capacities: 1) I 3 co gal. 2) f 3iv gal. 3) gal. <br />B. Pump Station (if required) <br />Pump make & model (attach pu np curve & <br />literature); system design requires gpm at meet of head. <br />High water alarm make & model Outside <br />electrical work to be completed by installer electrician <br />other Inside electrical work must be completed by <br />electrician. <br />C. Treatment System: C(o <br />Trenches: - s.f. Mound <br />Depth of rock below pipe Rock bed dimensions 'x ' <br />J�_ Drop Boxes Sand bed dimensions 'x ' <br />Distribution Box Pressure Dist. Pipe Diam. " <br />Maniford Pipe Diam. " <br />D. Final Cover/Topsoil to be: _K 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 <br />permit, agrees to do all work in strict accordance with the ordinances of the City and the <br />regulations of the State of Minnesota, and certifies that all statements made on this application <br />are complete, true and correct. <br />SignatureofApplicant:JL-,,- ,P /� 0,1, Date: /0-2F-9 ? <br />MPCA Certification No.: <br />Staff Review: Approval Denial <br />Reviewer: - Date: ��� <br />Reason for Denial: <br />