HomeMy WebLinkAbout1994-11-03 Application for Septic System PermitT
CITY OF ORONO
Box 66 (2750 Kelley Parlcway)
Crystal Bay, MN 55323
JOB SITE ADDRESS; ^
SEPTIC SYSTEMPERMU APPUCATION
Occupancy Type; Residential Conunercial
Permit Type:New or Replacement Syst<
Repair Exiking System,
$100.00
$50.00
Other
/^£>
0.50 State v.harge idded to abore fees
*See fee schedule for non-residential permit fees
Owner’s Name;
Mailine Address;Z 7^7/^ / ^Mailing Address;77z^7 A/£City;^gI^:^>^l Zip; ^^0^0
Contractor’s Name; / ^ Phooehhim^
Mailing Address; " City;^^^g^trv^ jf fl/J
NOT MAIL PAYMENT WITH THIS APPUCATION
GENERAL INSTRUCTIONS ^ . u
1 Applications for septic system permits may be mailed or submitted m person at the City
Offices: however, permits wUl not be maUed out. The permit must be picked up in
person at the City Offices and wc^x must not begin unless the pennit card is on the job
site.
2.
3.
4.
5.
Permits will be issued only to contractors holding a City of Orono Septic System
Installers License.
All worit must be done in accordance with the approved septic syst^ design. Desig^
reports are not considered approved unless accompanied by the "City of Orono Septic
System Approval" cover sheet signed by the City Inspector.
The following inspections will be required for all septic systems:
A. Pre-installation site inspection to include inspector, installer, and general contractor.
B. Tank installation prior to covering.
C. Drainfield trench installation prior to covering. For mou^, mspecnon is tequirea
after rough-up but prior to sand placement (sand will be jar tested for silt content),
a^ again during pressure distribution piping installation in the rock bed.
D. Final L ipection to verify proper final cover depths: and to verify that all pump station
(where required) components are functional and comply with codes.
Individual holding MPCA InstaUer Certificate shaU be present during inspections. A 24-
hour notice is required for all inspectfons.
NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate
boxes.
1. I have received a copy of the system design including the City of Orono
Septic System Approval Cover Sheet.
2. I will be installing the following:
A. Tanks: ^Precast Conwete
Tank Capacities: 1) fxXl gal.
B. Pump^tion (if mqui
Pun^pTHlllr A iiiin|<1
literature); system desi]
High water alarm
electrical wor|U»‘be^mpleted by
ofhec..^—Inside electrical work must
electrician.
C. Treatment System: .
DepA of rock below pipe 1
Mound
ep^<
S^Drop Boxes
Distribution Box
Rock bed dimensions
Sand bed dimensions
'X
*x
Pressure Dist. Pipe Diam.
Maniford Pipe Diam.___
'Yc D- Final Cover/TopsoU to bf X borrowed from site
<7 I ^ (show location on site plan)
A. trucked in
The undersigned hereby applies to the City of Orono for issuance of a septic system installation
Dcrmit agrees to do all work in strict accordance with the ordinances of the City ^ the
regulations of the State of Minnesota, and certifies that all statements made on this application
are complete, true and <^npetr~^
Signatureof^jpli
MPCA Certification No.: f 3
Staff Review: Approv Denial
Reviewer:
k I. I for Denial:
<
..iiH ■Ota