HomeMy WebLinkAboutApplication for septic permit . _ _ -
. __ - - - --- -
� _ __- � -- -
: ;_ .
_.:__�.
, , _ , - _�_ _, � � -
:;_. - , -_ _ . -_ , . ., . _ ' - �
_ .
_ �� f S t_ ' _ �_
.' A�PI.=I�TION FOR'' S�PTIC SYSTF�i PEFtI�SIT � - _ - ��- J����- —,- � ' _;
.,.. �. _. . , __�, ,
_ � -- ��? �� ��_. %? n,
_ _ . ..
� - � � --�=-- � ; `t ���' ��1
li%� -� � '���-'
CITY OF ORONO � ' � "
Box 6 0' (13 3 5 So Broxn Rd) -. p __�� _ -
Crystal Bay, � 5�323 _ . __ ' �- SE 2 n ����a ,
t:::*t***:�:*t�t**:**:**tfffftt*:t****#�*�:#:*#*�:*t #f#***�***�#:*� ���
� ;
General. Instructions:
1. You may a��Iv for segtic system permits by iaail o erson � the
City offices. However, per�aits will not be mailed out be
pic?�ed up in person at the City offic�s.
2 , p��its are not valid until you receive a gerntit card.
3 . Work must not begin unless the germit� card is available on the job
site. . . -
4 , Permits will be issued only to contractors holding a City of Orono
Segtic Syste� Installer`s Lic�nse.
5 . Ali wvrk must be done in accordance with the approved septic syste�
design. Desicn re�orts are not considered a�proved unless accom�anied
by tne "City of Orono Septic System Ap�roval" cover sheet signed by
the City Inspec�or. �
6 . The following ins�ections will be required for all septic systems :
a) Pre-installation site inspection to include inspector, instal Zer,
and general contractor.
b) Tank installat=on prior to covering.
c) Drainiield trench installation prior to covering. (ror mounds,
inspection is required after rough-ug but prior to sand
p lacement, and again during pressure distribution piping
installation in the rock bed.)
d) Final ins�ection to verify proper final cover depths and to
verify that aIl pump station (wnere required) com�onents are
functional and comp ly wi�h codes.
7. Individual holding MPCA Installer Certificate shall be present during
all inspections. 24-hour notice is reauired for aIl ins�ections.
:yr�ez#z�rsz�zza#iisi:icsi:��wt��tt==�==+==-t-t�+±`t�t±±�t�tt�r�t�firatf*tf�t#**f*f'*f*:t*
r �� �) ,,�/
JOB SITS BDDRESS: � � � �✓ ��""�-' `
Occupancy Type: Residential Commercial Other�,
Owner' s Name: /o .� _ . P�+one:
�iailing Address: City: Zi�= ,
� � Bus. Phone:�S/'
Se�tic Contractor' � u�*^�. � t
!�tailing Address: - �- �- City: - - - Zip:��_�
at�ir#**2�#*�t*��t*#s*��a�t�t*�es�t�t �t�t�tz�t*s�tvtf��'�*#�ktt*��t�t**�t�lr*�t*tf#�yt�����t�t�t��t
- oner -
� S � � .
�� � �
'� �� -2 `�-��
�f�-�
v . _ - --
�_.
,_„ ,_ : ,- - - - __ _ � _ . _ .... .. . _
_..::� �,=4..:,_.: _, _ .- ;'. ,_. . .. _ _
.. .a.r_ . � _ _. - - - - = - - - �
,a-� --� -. -�-- : � - ..
_ _ . .
.._ _ -
:
. � - �
, �_ . ._.:..; , . . � �=�- . . .. . �.`'-� _`�
- _--.�____. -._ __ ._.:..� _—. � rn�;�� Y -,� « .y.t;� .,�' .,�,,:.�.....r...
.
.�. . , . .__� �- - - --�
S�PTIC SYSTrM -PffitMIT APPI,IC.�TON - PAG� 2 �--- - �-- --- - _ _ _ _ _ _. .- -.
� Per.nit Typ e � Fe�s (cse�.� one) ;-� . .^__ - _ � -
New Construc�ion, Full System $75.00. . . . . . . . . . . - . . . . . .
Replace Exis�ing System (1 or more new tanks &� drainfield) $50.00. . %� �
Partial Replacement (reglace just tanks or just drainfield) $30.00. . .
—--- •- ' ' - ' ...r_... �. - ' - ' - � _. .. _ � . .. . � _ . � . . ' .
$0.50 State�surcharge added �to above permit�: fe�s �. - _ -"
Sc�E FEE SCHEDIILE FOR NON-s'tESIDENTIAL PERMIT FEES
� DO NOT MAIL PA3�NT WITB THIS APPI,IC�TION
****f�*tt**f****#**#*:***********�****�*#*****ft*************f***f***#tff#*
NOTS: AD�Iicant must initial all spaces. Fill in all azprogriate blanks,
check aIl approFriate boxes.
Initial
�� 1. 2 have received a copy of the system design inciuding �he
. City of Orono Septic System A�nroval Coner Sheet.
2. I will be installing the following:
A. Tanks: Precast Concrete �Other Manufacturer
Tank Canacities: I)� �� gal. 2) ���gal. 3 ) gal.
B. Pumn Station (if required)
Pump make & model (attach gump curve &
literature) ; syste� design requires gpm at fe�t
of head. High water alaraz make & model
Outside electrical work to be com�leted by _installer
electrician other Inside electrical work
must be completed by elec�rician.
C. Treatment System: -,-� �
��
' Trenches:�� . . Mound
�- ' De th of rock below pige " Rock bed dimensions 'x '
�� � Drop Boxes Sand bed dimensions _'x ' �
� Dist�ibution Box Pressure Dist. Pipe Diam.
Manifold Pipe Diam. "
D. Final Cover/Topsoil to be: borrowed from site � ,
(show location on site plan)
- --- ._ .. trucked in -
•#:*f*::***t*::*#�:**�:**t#**:*::*::******::::*:t*:*:�t*t*�****�***�*******
':�e undersigned hereby applies to the City of Orono for issuance of a
zptic system installation permit, agrees to do aIl work in strict
ccordance with the ordinances of the City and the regulations of the State
� Minnesota, and certifies that alI statements made on this application
=e complete,. true and correct. � -
ignature `of A�plicant: �QQ �- Date: � ���
. _ _ __ - _.__ ._
_ _ . _ _.
?CA Certification No. : � ..