HomeMy WebLinkAbout2017-01323 - septic repair � �`` CITY OF ORONO
2750 KELLEY PARKWAY * 2 0 1 7 — 0 1 3 2 3 *
DATE ISSUED: 10/16/2017
ORONO,MN 55356-
(952)249-4600 FAX: 952)249-4616
ADDRESS : 1300 SIXTH AVE N
PIN : 26-118-23-31-0004
LEGAL DESC : LTNPLATTED 26 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : SEPTIC
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REPAIR
ACTIVITY : SEPTIC(OTHER)
NOTE: SEPTIC REPAIR
APPLICANT SEPTIC REPAIR 100.00
ROTO ROOTER SERVICES CO. TOTAL 100.00
Payment(s)
14530 27TH AVE.N. CREDIT CARD 8714 100.00
MINNEAPOLIS,MN 55447-
(763)519-3907
OWNER
COFFINDAFFER,CLARENCE
1300 SIXTH AVE N
LONG LAKE,MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable Ciry approvals,and the
State Building Code. This permit is for only the work described and dces
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in confortnance with the State Building Code.This permit may be �
revoked at any time for due cause.
���f��/ '� /l� llla //7
Applicant Permitee Signature D te Issued By ature Date
1 - +
�p� Clty Of OI'OIlO FOR CITY USE ONLY
O P P.O.Box 66
2750 Kelley Parkway Date Received:
� Crystal Bay,MN 55323
z�* �. Phone:(952)249-4600 Permit#
�'�ktsnoa� Fax: (952)249-4616 Apptoved By:
Amount$:
CITY OF ORONO -SEPTIC SYSTEM PERMIT APPLICATION
(All permits must be approved by the On-Site Septic Manager and/or Building Official)
,�� ;�it�.l O�m��'lr�forn���r�:
Site Address: __ " >:.t' �,v��9v;y JZ�� �,,
Owner: ('•�r�ai�.�i" (;��,,J �,� t�-�2 Mailing Address: ���;�� C.i�� r2��• �.�
City: (�,i,2� ��:� Zip: � ��3 S�(�>
Home Phone: �C`� --�S ��� � `5 l� � Alternate Phone:
�t�tr��#�r 1��ilic:�+�t i
Contractor/A �- � -���,r�N'L '�
PP� tz Contact Person: �;
Address: ��I'�3v �7� �v:� �"� State License #: _ P►�1 C�J� ►� � '
C�tY= ��`��^�`� `�'� Zip: SSZ-I �1 � Expiration Date: 1 Z� �i
Phone: ��-Z lo�1 2 �G�� �—,--� \�t
Alternate rhone: 7k��• 2 i�: r � Z-\� fv
` � �S 13F �CCUPANC'�t' , ���`�, ' �. ;�
� �s � .,� -
. .. .
..� �,
�Residential ❑ Commercial ❑ Other
� ** ATT�NTtON APPLICANT ** �',
, Eiii in al! � ro riat� bl��nks ant� check all a ��ro r�ate boxes: _ ' �_ _� `�`
Tanks:
�'Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other:
Number of Tanks: �
�
Size of Tanks: '
Type of Activity:
'Trenches ❑ Mound ❑ Pressure Bed ❑ Chambers ❑ Holding Tanks
�;
❑ Pre-Treatment ❑ Other
NOTE: Provide an As-Built of the system before the final inspection.
A 24-HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS.
Page 1
� - 1
'PER11i�1�'i'1�P� Al+�fl��ES . , , ,,
New or Replacement System $400.00
Repair Existing System 100.00 ��-�"--%� ���"�
(Tanks or Drainfieid)
Total � ��"��. Cj��
The undersigned hereby applies to the City of Orono for issuance of a septic system
installation permit, agrees to do all the work in strict accordance with ordinances of the City
and regulations of the State of Min�►esota and certifies that all statements made on this
application are complete, true an¢-�orrect.
r'�'�}� Date: � I �
Signature of Applicant ti �
MPCA License No.:
Staff Review: ❑ Accept ❑ Denied
Reviewer: Date:
Reason for Denial:
Comments (to be printed on inspection card):
,,,
:;.g .:� �a t.-: ��. ERA�. #N�T�I,�CTl4NS
1. Applications for septic system permits may be mailed or submitted in person at the City
offices; however, permits will not be mailed out. The permit must be picked up in person at
the City offices and work must not begin unless the permit card is on the job site.
*** DO NOT MAIL PAYMENT WITH THIS APPLICATION ***
2. Permits will be only issued to contractors holding a Minnesota Pollution Control Agency
(MPCA) Septic System Installers License.
3. All work must be done in accordance with the approved septic system design.
4. The following inspections will be required for all septic systems:
A. Tank installation prior to covering.
B. Drainfield trench installation prior to covering. For mounds, inspection is required after
rough up, but prior to sand placement (sand must be jar tested for silt content) and
again during pressure distribution piping installation in the rock bed.
C. Final inspection to verify final cover depths and to verify that all pump station (where
required) components are functional and comply with codes.
5. MPCA licensed Installers or their DRP (Designated Responsible Person) shall be present
during all inspections.
Page 2
DATE TIME "
CITY OF ORONO cnLLED IN
INSPECTION,1 IQTICE SCHEDULED �j]�j� �
PERMR NO. GU � COMPLETED ���� �
i �
ADDRESS��� ��l�
OWNER TELEPHONE NO.
CONTRACTOR
� DESCRIPTION ���l� N� ll �� �a��
t�y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
�O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
� ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_ ❑ DEMO-SITE �EPTIC INSTALL
v
i 01NNEIVCOIdTNACTOR TO MEET YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑PROJECT COMPLETE
� ❑CORRECT W'ORK 3 PROCEED ❑ISSUE CERTIFlCATE OF OCCUPANCY
❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CONERINf3 PERMANENT
❑CORRECT UNSAFE CONDiT10N WITHIN H��- ❑pf{pT0 TAKEN
INSPECTOR WILL RETURN
O GTATION ISSUED
❑STOP ORDEH POSTED.CALL INSPECTOR
O INSPEC710N REUUIRED.CALL TO ARRANGE ACCESS.
Catl forthe next Mspectfon 24 hours in edvance. (952) 249-4600
OwnerlContra on site:
InspecMr.
WMb CapyAnspector's FlM C�nary CopyBiM Nodes