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� <br /> NO�'E: Applicant rriust initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. � <br /> �?� 1. I have received a co of the s stem de '� ' ' Q <br /> py y si�n includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. <br /> � 2. T �vill be installin� the followin�: <br /> A. Tanks: riPrecast Concrete Other Manufacturer�A�`''� � <br /> Tank Capacities: 1) t� �al. 2) 5'CX� �al. 3) � gal. <br /> B. Pump Station (if required) ��,,, �� <br /> Pump make & model (,c�r US�I (attach pump curve & <br /> literature); system desi�n rzquires 3 ; gpm at L � feet of head. <br /> Hi�h 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: / <br /> Trenches: s.f. ✓ Mound <br /> Depth of rock below pipe " Rock bed dimensions l J 'x �;� ' <br /> Drop Boxes Sand bed dimensions lo;� 'x_�3 ' <br /> Distribution Box Pressure Dist. Pipe Diam. / �, ,� <br /> Maniford Pipe Diam. z " <br /> D. Final Cover/Topsoil to be: �bonowed from sice <br /> �w location on site plar) <br /> trucked in <br /> The undersijned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, a�rees 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 /> Si�natureofApplicant: � <br /> Date: � � s 'S � <br /> MPCA Certification No.: Cq �� � <br /> Staff Review: Approva� Denial <br /> � Reviesver: Date: �'�-�`��_ <br /> � v <br /> Reason for Den.ial: <br />