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Home My WebLink About2014-01324 - new septic f � CITY OF ORONO * 2 0 1 4 - 0 1 3 2 4 * 2750 KELLEY PARKWAY DATE ISSUED: 1 Ul3/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1480 SIXTH AVE N PIN : 26-118-23-32-0008 LEGAL DESC : DOUGLAS ESTATES : LOT 001 BLOCK 001 PERMIT TYPE : SEPTIC PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : NEW ACTNITY : MOUND SYSTEM- SEPTIC APPLICANT SEPTIC NEW 200.00 STATE SURCHARGE SEPTIC 5.00 HAYES& SONS EXC. INC. TOTAL 205.00 263 82ND STREET S.E. Payment(s) MONTROSE, MN 55303- CREDIT CARD 5293 205.00 (763)479-1762 Minnesota State License#: sept-L640 OWNER GULBRANDSON, DAN& ERICKA 1480 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 speciYications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions oY laws and ordinanccs governing this type of wark 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 conlormance with the State Quilding Code.This permit may be revoked at any time or due causc. _- � ' . "� � � `�� ! i � i/ Ap icant Permitec-Sig ature Date � Iss e y Signature Date � � 1 ��ti��%�/�� ^ / � 1 � � O�� C�R��N(� r .SL�et Acldress: ilR�ailinc�Adirress: le�e�har,� ;452;`'1.4.;tf,;.,ii � � �!5(7 Ke�lay Par±cway 'O. i3ox f�o F�x (95� !Y9-qbto .��.� C-•ono, 1`��N 55�356 �rystai F>ay 'N ii3�3 ��v��.�i vr'or,o.�Yir�.�y ,�� ' Septic System Permit Application Please c�mplete this applicaton completely. Failure to fill in all of the required information may result in a delay of processing your application. Submit this application, a complete copy of the site evaluation and the design at least 3 working days prior to the projected installation date. Site Address: J�j �y`1 � 'r /f.Y ,., � I �1�% �r��t Owner Name: � , � " Address: �� -2 Owner Home Phone: '�Z- �j � � 7 Work Phone: Desi ner: License# Desi ner Address: Email: Phone: Installer/Contractor: f ' ��-- License# � ��1 Installer Address '"` = Date to be Installed: c�YS.+w., � c.o�,1 . �, ,_ ,� - Install Email: f.� 1�� es •�� Phone: /� � ;�� Existin Se tic S stem E es: ves No Com liance Ins ection Date: General Lot Dimensions: widtn� oeptn: Total Area: (,acres or sq tt) Home T e: d'� i� f i^ � -, ,� #of Bedrooms (> Washer Water Softener Garba e Dis osa/ i Hot Tub/Whirl ool Dishwasher Well: Existin9 New (to be installed) �� Size of Casin : De th of Casin : PROPOSED SEPTIC INFORMATION Soil Types: Sizing Factor: Septic: New Replacement Addition Other Tanks: Qty: _ New Existing Total Tank Type Capacity Manufacturer Pump Station: Tank Type C�?c, Capacity r S C� �O Manufacturer � ,-�� (if applicable) Pump Size Type Failure Alarm Type Drainfield Total Length Total Width Maximum Depth Trenches w/rock Trench w//chambers Rock below pipe inches Pressure Bed Mound Other(explain) Mound Dimensions: Rock Bed x ft Absorption Area x ft Clean Fill below rock bed inches Filter: Type d� Manufacturer Alarm Type: New designs shall adhere to 2008 MPCA standards. OFFICE USE ONLY Permit# ��4�3?�t Payment Rec'd '�.� � Zoning District 'R'R' �(� Field Checked � Date Inspected New/Replace • 3 SKETCH: Submit licensed site evaluation, design, sketch and management plan with application. If substantial changes are made to the design during installation, a new design must be submitted with the date and designer's signature prior to installation and inspection. Completed Site Evaluation ,A�Yes ❑No Date I,, �ra��' i � Completed Design Worksheets ❑Yes ❑No N.4 Date Compliance Inspection ❑Yes ❑Noi✓✓� Date Management/Monitor Plan �`.;'t]Yes ❑No Date Approved �,� � �-• t � 1✓�� S ; ,��E' AGREEMENT: I/We the undersigned, hereby make application for work described and located as shown herein. I/We certify that the information contained herein is correct and agree to do the work in accordance with the provisions of the Orono City Code and the State of Minnesota MPCA Rules 7080-7084. I/We further agree that any plans, specifications, or drawings submitted rewit a e accurate and shall become part of the application. _ ///3--�c� Sig ture of Ho' eowner or Agent Date PERMIT: Permission is hereby granted to the above named applicant(s) to perform the work described in the above application. Any and all changes to the approved design shall be reported to the designer and to the permitting agency prior to the completion of the work. This permit is granted upon the express condition that the person to whom it is granted, and his/her agent, employees and workers shall conform in all respects to the Orono City Code and the State of Minnesota 7080— 7084 Rules. This permit may be revoked at any time upon violation of said ordinances and codes. This permit expires on December 31 of the year in which it is issued. This permit, with all supporting documents, will become a permanent part of the property records on file at the Orono City Hall. A! Communit Developme irector or Designee ate Return this Application to: Physical Address: Mailinq Address: City of Orono City of Orono 2750 Kelley Parkway P O Box 66 Orono, MN 55356 Crystal Bay, MN 55323 Phone :952-249-4600 ..,.., �� ;�._,;�_, � �� : _ _ __ _ Fax: 952-249-4616 :n;.,�k�ii!r,i ��r��r��i.ni�� ;�, Septic Permit—Revised 7/8/2014 Page 2 of 3 �` �� r f- �- � ,r-_... t �,; ._. .-, �! ��,� � f .�� i ► j ,��; ' � I l � 1 ' I � .� � � _.----- �� U l � �h�' y � T � � �, / � r z � T� / j s _ ,+ '� � , � � i 1� ;' � 'll _ � �� /� �� - 4.,�� j�� (��A � l� ��\� , Q � `�c � � �(- � � �� . - (- � �� -. � g - �SS�� , � _ (� S �� , . � _. .� _ . ,i . �� , J i � �""�r'�1ru � ; � �1. _ �,� J 1�C ��V7 ��F � v./ "� 1��\u y�� `� 2;, e .�. .., Q Q ✓ DATE TIME CITY OF ORONO �� CALLED IN INSPECTION NOTICE p`3��HEDULED PERMIT NO._ — COMPLETED / �T� ADDRESS D i a� OWNER TELEPHONE NO. CONTRACTOR � DESCRIPTION 4� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAI FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ v ❑ DEMO-SITE ❑ SEPTIC INSTALL Z OWNEpICONTRACTOR TO MEET YpU:_YES_NO � CO MENTS: 0. ��m � � � ecr� v� - � 0 � ° iLa; '— � ►�ov�� d�'i,4 �2�z' W � Q z '��u� �� r� ,� S � w � � J d W� ❑WORK SATISFACTORY:PROCEED �PROJECT COMPLEfE w ❑CORRECT WORK 8 PROCEED �❑ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECaVERING PEpMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. O PHOTO TAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED �STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (g52) 249-46�0 on site: Inspector: Whits Copyflnspectors File Gnary CopylSite Not{ce