HomeMy WebLinkAbout2010-01098 - septic repair CITY OF ORONO PERMIT NO.: 2010-01098
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 11/16/2010
952 249-4600 FAX: 952 249-4616
ADDRESS 125 TRUFFULA TR
PIN 33-118-23-44-0041
LEGAL DESC MEADOW WOOD POND
LOT 007 BLOCK 001
PERMIT TYPE SEPTIC
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE REPAIR
NOTE: REPAIR SEPTIC
APPLICANT SEPTIC REPAIR 100.00
ELMER J. PETERSON COMPANY STATE SURCHARGE SEPTIC 5.00
5921 DAGUE AVE SE TOTAL 105.00
DELANO, MN 55328
OWNER
JOERRES,JEFF&KELLY
125 TRUFFULA TR
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 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 conformance with the State Building Code.This permit may be
re o t any time for due cause.AtM— /
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rcant Per 'tee_Signature Date Issu By4SignaeDate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
O' City of Orono P-)F) R USE ONLY �}
P.O.
00 KoXley Parkway Gate Received/66 I D Permit o d !8
Crystal Say,MN 55323
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(952)249-4800 Amount S
CITY OF ORONO- SEPTIC SYSTEM PERMIT APPLICATION
(All permits must be approved by the On-Site Septic Manager and/or Building Official)
Job Site / Owner Information:
- rf Site Address: � -� / - - 92
Owner: (/ �i� �/y ��'��S Mailing Address: �-
City: d'fD 4/0 Zip:
Home Phone: Alternate Phone:
Contractor/Applicant Information:
Contractor/App.:4!FZM,e:5�e' � Contact Person:
Address: State License* #a/
City: Zip: Expiration Date:
Phone: ��. R,7.? Alternate Phone: A;
TYPES OF OCCUPANCY
Residential ❑ Commercial ❑ Other
PERMIT TYPE AND FEES
New or Replacement System $200.00
Repair Existing System 100.00
(Tanks or Drainfield)
State Surcharge 5.00 5.00
Total $ log::�
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112
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ATTENTION APPLICANT'"
Fill in all appropriate blanks and check all appropriate boxes.
I will be installing the following:
Tanks
Precast Concrete ❑ Fiberglass ❑ Plastic ❑ Other
gist rrmufactur+er)
Number of Tanks:
Size of Tanks: L�
Treatment System
Trenches s.f.
Mound s.f.
Gravel less s-f.
Chamber s.f.
NOTE: The contractor is required to provide 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, true and correct.
i
Date:
Signature of Applicant ,
MPCA License No.:
Staff Review: hCAcce pt ❑ Den led
Reviewer. Date_
Reason for Denial:
Comments (to be printed on inspection card):
Reset Form
W.VPermb)1Sepdc Permit Application-Updated Surcharge 7-1-10.doc
212
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CITY OF ORONO CALLED IN / " AJC)-'Z-po
INSPECTION NOTICE QCHEDULED
PERMIT NO.aW_l��/eq VQ COMPLETED
ADDRESS
OWNER TQL HONE NO. Fa 7
CONTRACTOR
Qk
DESCRIPTION
❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
O El TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS
❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT
❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ [I DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v E] PLUMBING RI ❑ SEPTIC FINAL ElFOUNDATION/REMOVAL
Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO
COMMENTS:cc
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62 'X.
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LU ❑WORK SATISFACTORY:PROCEED ,f!kPROJECT COMPLETE
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W ElCORRECT WORK&PROCEED F-1ISSUECERTIFICATE OF OCCUPANCY
C) ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
El CITATION ISSUED
11STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site:
Inspector.
White Copy/inspector's File Canary Copy/Site Notice