05-09-2022 Council Work Session Packet

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Hennepin County Public Health 1011 South First Street, Suite 215, Hopkins, MN 55343 612-543-5200 | Epi-envhlth@hennepin.us 2022 SEPTIC PERMIT APPLICATION PUBLIC HEALTH A septic permit must be obtained before beginning any activity requiring a permit under Hennepin County Ordinance No. 19 – Individual Sewage Treatment Systems Standards. Please check the activity below, then submit application, fee and complete design to this office. It is the duty of the applicant to notify the Health Authority at least 24 hours before the date/time the inspection is needed. [excludes weekends/holidays] Checks or money orders should be made payable to: HENNEPIN COUNTY TREASURER. Permit expires one year after date of issuance. Owner Name: Parcel Id No.: Site Address: City / Zip: Activity Permit Fee & Supporting Information  Type IV or V septic system requiring an operating permit $721 – site evaluation and design  Type I, or III (floodplain) septic system installed by owner $504 – site evaluation and design  Type I, or III (floodplain) septic system installed by licensed installer $405 – site evaluation and design  Type II holding tank installation, privy or a septic tank replacement $200 – site location  Septic system rejuvenation $99 – site location, activity report, outcome  Abandonment of a system/tank(s) $99 – pumping record and site location  Septic tank pumping filing fee $36 – activity log and site location  Operating permit renewal fee – Residential $95  Operating permit renewal fee – Business $193  Septic review for newly platted subdivision or lot split $185 – per lot  Design revision submitted AFTER permit approval $150 – requiring additional design review  Septic system inspection fee – per time $150 Total Fees: $ •Permit fees include design/plan review and construction inspections. •A permit is required for abandoning an existing system that is not part of the installation of a new/replacement system. All systems must be pumped prior to abandonment. •Conditional approvals of abandonment will be issued pending receipt of SSTS Abandonment Reporting Form required by state law to be submitted within 90 days of abandonment. [We request 1 or 2 photos of the abandonment in process as well] Designer: Name Address MPCA License No. Installer: Name Address MPCA License No. Maintainer: Name Address MPCA License No. I certify that the information on the forms provided are accurate and complete. Please print clearly where appropriate. Applicant Name: Company: Email: Phone: Applicant Signature: Date: □Site Staked? Date Staked If the septic location cannot be determined during permit design review, a Reinspection Fee of $150.00 will be charged to the Applicant. Installers—Please Note! Elevations at rough-up and rockbed inspection will be completed to ensure the required system separation identified in the design have been met. ONCE APPROVED A COPY WILL BE RETURNED TO YOU WITH THE APPROVING INSPECTOR’S NOTES HERE.