HomeMy WebLinkAboutOnsite sewage treatment system PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: P04938
Crystal Bay, Minnesota 55323 Permit Type: user Defined
(952) 249-4600 Date Issued: 5/17/2002
SITE ADDRESS: 1850 Fox Ridge Rd
Long Lake,MN 55356
PID: 03-117-23-13-0008
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(501+cu yds
DETAILS:
Approved per resolution#:
Separate permits required:
Other-(Final)
NOTICES/REMARKS:
Approved per conditions of resolution#2732 zoning file
FEE SUMMARY: Permit Fee: $ 75.00 Valuation: $ 0.00
TOTAL FEE: $ 75.00
APPLICANT: Owner/Self OWNER: Revis&Meghan Stephenson
MN 1850 Fox Ridge Rd
Long Lake,MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Sienitures Required), 1-Applicant, 1-Month1y Reports, 1-Assessine, 1-Finance Page 1
1, Total Fee: $ Date Received: CV1;
Entered By: Permit#:
CITY OF ORONO - PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SITE ADDRESS: < ' lZIP:
NAME OF OWNER: v i 5 ��,�'+n y� PHONE: (home) �,5 q7r S `(
(work) �( h: 370 �a 7 7
MAILING ADDRESS: Su ,,, , _ CITY: ZIP:
CONTRACTOR: ZA PHONE:
CONTACTPERSON: is 5,� ��� „� MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration,.,- Land Alteration
PROPOSED WORK (describe in detail): Zekw 01 /911�1)t) ry�
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City and with
the State Building Code; that I understand this is not a permit and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANTS SIGNATURE: �' �--� DATE:
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. Information required to be given Individual. An individual asked to supply private or confidential data concerning himself
shall be informed of. (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide
system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or
refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.
This requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law
enforcement officer.
The commissioner of revenue may place the notice reouired under this subdivision in the individual income tax or property tax refund
instructions instead of on those forms.
Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the
subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who
is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed
of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be
disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been
collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data.
The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies.
The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days
of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with
the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,
excluding Saturdays,Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or
private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the
disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify
past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data
to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating
to contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your
request for a permit or license from the City of Orono or any of its departments may require you to furnish certain
private or confidential information.
You are notified that:
1. The information you furnish will be used to determine your qualification for the permit or license
requested.
2. You may refuse to supply data, but refusal may require that the City deny the permit or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to
process the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04(available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address
City State Zip Phone
I understand my rights as stated above.
Signature
6
CHECK OFF LIST FOR ISSUANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAL: 1 1bSb 170y-
PID: oy-PID:
DESCRIPTION OF WORK: L,A N 6 141-TZ-72A 7?oN
ZONING REVIEW BY: DATE APPROVED:
BUILDING REVIEW BY: to DATE APPROVED:
,p ------------------------------------------
FEES TO BE CHARGED: T w M c Fees Calculated By:
PERMIT Yes _ ( No
PLAIN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes No WATERCONNECTION
INVESTIGATION FEE Yes No PARK FEE
SAC Yes No SITEINSPECTION
Number of SAC Units OTHER (specify)
ZONING CHECK LIST Zoning District: 2(-L- I r3
Fire Department: 4- L Post Office: L School District: O!2 o n/O
Lot Area: Sq.ft. Acres Width Depth
Survey Submitted: Yes X No Date of Survey:
Proposed Setbacks: ,
Front (Lake): Right Side:
Rear (Street): — Left Side:
sf
Adjacent Structures: — Wetland: 2-
Building Height: Def. Hgt. — Peak Hgt. —
Lot Coverage: /�
Grading: Staff Approval Date: 3—t t 'u Z By:or Q - Council Approval Date: �!• Zb- 1
Septic: Staff Approval Date: By:
Zoning File: # 2")3 Z Resolution: # Resolution Date: I "Z b ' o 1
Shoreland District: NO
Avg. Setback: Bluff Setback: Lot Coverage:
Existing Proposed
Hardcover: 0-75'
75-250'
250-500'
500-1000'
Hardcover Variance Required: Yes No Date of Council Approval:
REMARKS (in house): c%/v(c,(^J a e1Li.vc
7
BUILDING REVIEW CHECK LIST
UBC: `— CONSTRUCTION Ee
Sq Footage $Per Sq Ftg
Basement x =
1st Floor x _
2nd Floor x = .
Garage x =
x —
TOTAL
Estimated Construction Value: $ CANO AC�r67t4170n/ w i 7W C•
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Fire
Hardcover Removal Mechanical Water Connection
Footing Septic Sewer Connection
Framing Fireplace Lawn Irrigation
Insulation (Masonry) Other
Wall Board (Mfg.) Well(State Permit)
_a.g Final Grading/Filling Electrical(State Permit)
Other
REMARKS(IN HOUSE):
REVIEW BY OTHERS: DATE: ---____-�-�_-
Access: Existing New
Access Approval: Date By:
REMARKS-(TO BE NOTED ON PERNEM: 1q Pt0rtojc<9 „/1�+.•� CoN n eit5
8 . .
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CITY of ORONO
Municipal Offices
Street Address: Mailing Address:
9kE3H�¢ 2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: { ��'�}'' ti C/aJt� l �'-.. Address: 1850 Fox Ridge Rd.
Permit m's: 6124 Dates: 9/29/80 Contractors: Sullivan
(This is [ Al an existing system [ ) new construction) .
SYSTEM COMPLIANCE (1-3) : 3
1 Code System: Meets or exceeds current City standards in all respects relating to design,
construction, and location. Appears to be operating properly.
2 Compliant System: Does not meet all current City standards for new construction, but in
most respects appears to be designed, located, and constructed in accordance with previous
codes and is functioning properly.
3 `I Non-Compliant System: System may or may not meet current City standards for design,
construction, or location, but is failing to properly treat and dispose of the current
input; and any system with less than three feet of vertical separation between the bottom of
the drainfield and the saturated soil level.
(The saturated soil level is [ �` ] or is not [ ] identified under this septic system. If the
saturated soil level is not identified, this classification is subject to revision.)
TANK CONDITION (5-9) : 9
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year.
7 System is discharging to the surface. Tanks must be pumped out within 48 hours.
9 Inspection risers missing-tanks could not be inspected. If tanks have not been pumped out
within three years, they should be pumped out and risers installed now.
9 Inspection pipe is located over tank baffle-can not measure solids accumulation. If tanks
have not been pumped out within three years, they should be pumped out now.
10 One or more tanks are cesspools, which means the septic system is non-compliant.
(The tanks are [ ] or are not [ ] water tight or the condition is [ unknown. If the tanks
are not confirmed to be watertight, this classification is subject to revision.)
DRAINFIELD CONDITION (11-14) : 13
11 Drainfield is dry, no surfacing evident.
12 Some evidence of surfacing, not critical yet. Repair is not required at this time.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact
the City Inspector immediately. Repair must be completed within 90 days.
14 Drainfield extent and condition unknown.
POTENTIAL FOR SYSTEM FAILURE: (system age and condition, soils, etc. ) : failing
COMMENTS: In order to confirm that your septic system meets Minnesota standards, soil borings
were performed to verify a 3 foot separation between the drainfield and the seasonal water table.
The separation is 1 foot and the system is non-compliant. Repair or replacement of the septic
system is required by 2/3/1999. r
Date of Inspection S n ;c System Inspector
i `
Note: In the event that this inspection report is used to satisfy the requirements for a
transfer of property, this report does not guarantee that an existing system will continue to
function properly, but indicates the operation of the system under current conditions.
Telephone (612) 473-7357 9 FAX 473-0510
CITY OF ORONO O
Municipal Offices O O
Post Office Box 66
Crystal Bay, MN 55323-0066 ON—SITE SEWAGE TREATMENT
INSPECTION REPORT
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Owner: �U/ l ��:1" 'f �I ��. Address: "i �� >� CSX 6' � .
Permit #'s: 601,ii Dates: ",22- 2 Contractors: LL2L
City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the category
checked below.
(This is A an existing system [ I new construction)
SYSTEM CONFORMITY (1-3): C
1 "CODE SYSTEM"-A system which meets all the location, design, and construction standards of the current City
Codes, and which is operating satisfactorily by treating and disposing of the entire current sewage input
without discharging any pollutants into ground or surface waters.
(7� "CONFORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the
current City Codes, but was installed according to the code in effect at the time of installation, and which
is operating satisfactorily by treating and disposing of the entire current sewage input without discharging
any pollutants into ground or surface waters.
3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any
system which may or may not meet all the location, design, and construction standards of the current City
Codes and which is failing for any reason; and any system with less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soil characteristics.
(The limiting soil characteristic [ ) has or p4—has not been identified at this time. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDITION (5-10):
Tank inspection indicates:
5 Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Tanks should be pumped out as soon as possible.
8 System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface discharge.
9 Inspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
tank at next pumpout. If tanks have not been pumped out within the last three years, they should be pumped
� out now.
(1 10� Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
If tanks have not been pumped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14): 1
Drainfield inspection indicates:
Drainfield is dry, no surfacing evident.
If(1 Some evidence of surfacing, not critical yet.
Drainfieldis saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately. Repairs must be completed within 90 days.
14 Drainfield extent and condition unknown.
LIMITING SITE FACTORS (slope,setbacks,etc.): )
`J�xit.'a
POTENTIAL FOR SYSTEM FAILURE (depends on soils,water table,etc.):
COMMENTS:
Date of Inspection S p c Syste nspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of
property, be advised that this report does not guarantee or certify that an existing system will continue to function
properly, but is merely an opinion of the adequacy of the system under current conditions based on the available
information.
This report must be kept on the premises with the system location and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
CITY OF ORONO 0
Municipal Offices O O
Post Office Box 66
Crystal Bay, MN 55323-0066 ON—SITE SEWAGE TREATMENT
INSPECTION REPORT
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Owner: �f.�1;k Y;l ✓ Address:
Permit #' s: Dates: r _j. ;,1 Contractors:
City ordinance number 100 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.
The on-site sewage treatment system at the above address has been inspected and appears to fall into the category
checked below.
(This is [1. an existing system [ I new construction)
SYSTEM CONFORMITY (1-3): C;�'
1 "CODE SYSTEM"-A system which meets all the location, design, and construction standards of the current City
Codes, and which is operating satisfactorily by treating and disposing of the entire current sewage input
without discharging any pollutants into ground or surface waters.
2 "CONFORMING SYSTEM"-A system which does not meet all the location, design, and construction standards of the
current City Codes, but was installed according to the code in effect at the time of installation, and which
is operating satisfactorily by treating and disposing of the entire current sewage input without discharging
any pollutants into ground or surface waters.
3 "NON-CONFORMING SYSTEM"-A prohibited system; a system located within a designated 100-year floodplain; any
system which may or may not meet all the location, design, and construction standards of the current City
Codes and which is failing for any reason; and any system with less than 3 feet of unsaturated soil or sand
between the distribution device and the limiting soil characteristics.
(The limiting soil characteristic [ I has or [ I has not been identified at this time. If the limiting soil
characteristic has not been identified, this classification may be subject to revision.)
TANK CONDITION (5-10):
Talk inspection indicates:
5. Pumpout not needed at this time.
6 Solids accumulation in tanks indicates they should be pumped out this year to help prevent future problems.
7 Solids accumulation in tanks is at a critical level. Tanks should be pumped out as soon as possible.
8 System is discharging to the surface. Tanks must be pumped out within 48 hours to eliminate surface discharge.
9 Inspection risers missing-tanks could not be inspected. Inspection risers (4" dia. pipe) must be installed in each
tank at next pumpout. If tanks have not been pumped out within the last three years, they should be pumped
out now.
10 Inspection pipe is located directly over tank baffle (does not give accurate measurement of solids accumulation).
If tanks have not been pumped out within the last three years, they should be pumped out now.
DRAINFIELD CONDITION (11-14)-
D 'nfietd
11-14):Dr3'nfietd inspection indicates:
?1 Drainfield is dry, no surfacing evident.
12 Some evidence of surfacing, not critical yet.
13 Drainfield is saturated and visibly discharging untreated effluent to the surface. Contact the City Inspector
immediately. Repairs must be completed within 90 days.
14 Drainfield extent and condition unknown.
LIMITING SITE FACTORS (slope,setbacks,etc.): ,
POTENTIAL FOR SYSTEM FAILURE (depends on soils,wa er table,etc.):
COMMENTS:
2� � r'
17
,1:r%?:;. _._ _. ,�•. L7'•^.: /��1, -.� , t9►`�� � t �'P rr��.�.. r`Xr,,-,_....,.j� .t' ir'. :X I1• Z! (;�s,.,.';�-(�
'7
ate of Inspection ptic System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of
property, be advised that this report does not guarantee or certify that an existing system will continue to function
properly, but is merely an opinion of the adequacy of the system under current conditions based on the available
information.
This report must be kept on the premises with the system Location and pumping records.
WHITE COPY/Inspectors File YELLOW COPY/Homeowner
-16 °4�
0 0
CITY of ORONO
ti Municipal Offices
ti
G
Street Address: Mailing Address:
2750 Kelley Parkway P.O. Box 66
Orono, MN 55356 Crystal Bay, MN 55323-0066
Owner: Address:1850 Fox Ridge Rd.
Permit #'s:6124 Dates:9/29/80 Contractors:Sullivan
(This is X an existing system [ ] new construction)
SYSTEM COMPLIANCE (1-3) : 3
1 Code System: Meets or exceeds current City standards in all respects relating to
design, construction, and location. Appears to be operating properly.
2 Compliant System: Does not meet all current City standards for new construction,
but in most respects appears to be designed, located, and constructed in accordance
with previous codes and is functioning properly.
Q Non-Compliant System: System may or may not meet current City standards for design,
construction, or location, but is failing to properly treat and dispose of the
current input; and any system with less than three feet of vertical separation
between the bottom of the drainfield and the saturated soil level.
(The saturated soil level [ ] has or [ has not been identified at this time. If the
saturated soil level has not been ident fied, this classification is subject to revision.)
TANK CONDITION (5-9) : 9
5 Pumpout not needed at this time
6 Solids accumulation in tanks indicates they should be pumped out this year.
7 System is discharging to the surface. Tanks must be pumped out within 48 hours.
8 Inspection risers missing-tanks could not be inspected. If tanks have not been
09pumpedout within three years, they should be pumped out and risers installed now.
Inspection pipe is located over tank baffle-can not measure solids accumulation. If
tanks have not been pumped out within three years, they should be
pumped out now.
(During the last septic tank Maintenance Pumpout the tanks [ ] were or were not
confirmed to be watertight by the licensed pumping contractor. If the were not
confirmed to be watertight, this classification is subject to revision.)
DRAINFIELD CONDITION (11-14) : 13
11 Drainfield is dry, no surfacing evident.
Some evidence of surfacing, not critical yet. Repair is not required at this time.
>13 Drainfield is saturated and visibly discharging untreated effluent to the surface.
l Contact the City Inspector immediately. Repair must be completed within 90 days.
14 Drainfield extent and condition unknown.
POTENTIAL FOR SYSTEM FAILURE: (system age and condition, soils, etc. ) : failing
COMMENTS: The failing septic system must be repaired by 10/31/96.
Date of Inspection Sept c System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a
transfer of property, this report does not guarantee that an existing system will continue
to function properly, but indicates the operation of the system under current conditions.
Telephone (612) 473-7357 0 FAX 473-0510