HomeMy WebLinkAbout2013-01295 - septic repair , . R
CITY OF ORONO * Z 0 1 3 - 0 1 2 9 5 *
2750 KELLEY PARKWAY DATE ISSUED: 12/16/2013
ORONO, MN 55356-
952 249-4600 FAX: (952)249-4616
ADDRESS : 4300 SIXTH AVE N
PIN : 31-118-23-12-0022
LEGAL DESC : SHARON HILLS
: LOT 000 BLOCK 001
PERMIT TYPE : SEPTIC
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REPAIR
NOTE: SYSTEM WAS INSTALLED THREE YEARS AGO-NOW IS BEING CONNECTED TO HOUSE.
APPLICANT SEPTIC REPAIR 100.00
MAIL-IN FEE 2.00
CLASSIC CONSTRUCTION STATE SURCHARGE SEPTIC 5.00
18542 ULYSSES STREET NE
EAST BETHEL, MN 55011- TOTAL 107.00
Minnesota State License#: sept-PB644393 Payment(s)
CREDIT CARD 8654 107.00
OWNER
GEHRMAN, ROBERT&MARILYN
4300 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 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 of laws and ordinances goveming 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 I80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cau e.
� l ,� �1���..� �.2,c,/lv i/_3
App icant Permite ure D Iss d By Signature Date
. . �
�O`y P 0 g X O�rono FO CI USE ONLY ;
� 2750 Kelley Parkway '���, Date ReoeiveG:� Permit 1f��� ��J"
Cryslal Bay.MN 55323 '
(852)249-4600 ' AmounC $ �o.s,O�
a a
y� �
C
l�fSH���
CITY OF ORONO—SEPTIC SYSTEM PERMIT APPLICATION
(All permits must be approvetl by the On-Sile Septic Ma�ager andlor Builtling Otficial)
' Job Site/Owner fnformationc�
Site Address: �'�'�C')tL^�,p�. -��.P. IV ����
Owner; �.��1 ���'1Y,�('41�tY1 MailingAddress: ,�SJS I'IYjI'111'�((�
l.Ctn.e�
ary: C��tX'1�lL,- ov�,�.Lle� zip: w�c�L��1� �I""7
Home Phone:__�l� a��G _ �U�$ Aitemate Phone: '�
Contractor/Applicant Inform�tion:
Contractor/App.:��t�`���LC, LU`yl`'i�U� Contact Person: Lc�,r�
Add ress: `��t-1 a �s ' -�� State�icense#: Q�7 ���-13 G 3
City: � Zip: `�J�� � Expiration Date: i� �i S
Phone: �C..P 3�4�� ���U Alternate Phone:
�
` `` TYRES F OECUPAl+ICY
�Residential ❑ Commercial ❑ Other
� . PERMIT TYPE AND FEES
New or Replacement System $200.00
Repair Existing System 100.00 �� • OC�
(Tanks or Drainfield)
State Surcharge 5.00 5.00
Total $
W:kApplicaUons,Licenae or Pertnit ApplicaUons)�Permits\Septic Permit Application-UDdatetl Surcharge 07-28-11.Ooc
1 /2
r .. ,
+ • M
' **ATTENTIQ�V APPLICANT**
� Fill in all appropNate blanks and check aW approp�ate boxes. i '
I will be installing the following:
Tanks
❑ Precast Concrete ❑ Fiberglass ❑ Plastic ther
(list menufaIXure�
Number of Tanks: �
Size of Tanks: ""
Treatment System G�- ���?�'m' ��-''` , � ��rJ �l�.
Trenches s.f. ��,��,�• -� ((�(��,,�..QlZ.
Mound s.f. �
Gravel less s.f.
Chamber s.f,
NOTE: The contractor fs required to provlde an As-Built of the system before the
final inspection.
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 Minnesota and certifies that all statements made on this
application are complete,t nd correct.
:
Signature of Applicant '" -� ,$�.�.�_ � Date: /d-!(p- !3
MPCA License No.:
Staff Review: ❑ Accept ❑ Denied
Reviewe�: Date:
Reason for Denial:
Comments(to be printed on inspection card):
W:\(Applications,License or Pertnit Applications)�PermitslSeptic Permit Application-Updated Surcharge 07-28-11.doc
2�2
� r . .,
u� ��`-" / DA TIME "
CITY OF ORO�O `" CALLED IN /� �
INSPECTION N TICE SCHEDULED / - - -/��
PERMIT NO. COMPLETED
ADDRESS
OWNER TEL HON N07 �-3���
CONTRACTOR �N
a DESCRIPTION � �
�
� � FOOTING ❑ PLUM NG FINAL ❑ EXCAV/GRADING/FIILING
Q O POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL ❑ SEWER HOOK-UP ❑ CpINpLAI►VT
J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ fOLLOW-UP
� ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI O SEP`TI�INAL ❑ FOUNbAT10N/REMOVAL
2 OWNERICONTRACTOR TO MEEf 1'�U:�11ES_NO
� COMMENTS: � _
� L,•� �C�• O �vC .m/e e. —
7
jr �— _ -_ ` «
� i'o .✓`_ �a� S r - ��•'��7�
)„ � .
� f�rn� � 2�f��S�i�4 .5�4��G �er[ � —
� y ...�
�D 5 G.�Gr_.t a�'�' �J r a�. .,t1 eo� -----
W
�
Q
�' /S/C �d C� v'c� .�'
�
W
�
j
� �IVORKSATISFACTOR�F PROCEED �OJECT COMPLETE
W ❑CORRECT W'ORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CARRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWRHIN HOURS. ❑pHOTOTAKEN
INSPECTOR WIIL RETURN ❑CITATION ISSUED
❑STOP OR�EH POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (g52) 249-4600
OWII@ CtOf O�l S� � 2 Q N
. a
Inspectoe
White Copyllnspector's Flle Canary CopylSite Notke