HomeMy WebLinkAbout1999-06-18 Application for Septic System PermitcrryoFORONO
Box 66 (2750 Kelley Parkway)
Crystal Bay, NIN 55323
SEPnCSYSTEMPERMETAPPLlCATION'J11^
JOB STIE ADDRESS:y3
Occupancy Type: * Residential
Permit T>*pe:
Commercial Other
New or Replacement System,
Repair Existing System,
(Tanks or Brainfield)
$100.00
$ 50.00
0.50 State surcharge added to abore fees
^See fee schedule for non*residential permit fees
Owner’s Name:
Mailing Address:5 .
PhoneNumber :
City;
Contractor ’s Name: ^
Mailing Address; 9-z^ <*/.
PhoneNumber ;
City: f>9^ Zto:
DO NOT MAIL PAYMENT 'WITH THIS APPLICATION
CENERAL INSTRUCTIONS
1. Applications for septic system pennits may be mailed or submitted in person at the Ciy
Offices; however, pennies will not be mailed out. The pennit must be picked up in
person at the City Offices and work must not begin unless the permit card is on the job
site.
2.Permits will be issued only to contractors holding a City of Orono Septic System
Installers License.
3.All work must be done in accordance with the approved septic system design. Design
reports are not considered approved unless accompanied by the "Ciy of Orono Septic
System Approval" cover sheet signed by the City Inq>ector.
4.The following inspections will be required for ^1 septic ^sterns;
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 mounds, infection is required
after rough-up but prior to sand placement (sand will be jar tested for silt content),
and again during pressure distribution piping installation in the rock bed.
D. Final inspection to verify proper final cover depths and to verify that all pump station
(where required) components are functional and comply with codes.
5.Individual holdii^ MPCA Installer Certificate shall be present during iniq)ectioiis: A 24-
hour notice is required for all inspections.
1
'.5
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.
or€
A. Tanks: Precast Concrete
- Tank Capacities: Vi/0(7y gal.
Other ManufacturerX^^<^‘*''*^
2)il^gal.3) ____gal,*
/?cv>y» /iP \
B. Pump Station (if required) ^
Pump make & model jjJCb • (attach pump curve &
literature); system design requires gpm at So feet of head.
High water alarm make dc model Outside
electrical work to be completed by___installer electrician
other ___________. Inside electrical work must be completed by
electrician.. •
C. Treatment System:
Trenches:s.f.
Depth of rock below pipe
' Drop Boxes
____Distribution Box
D. Final Cover/Topsoil to be:
Mound
Rock bed dimensions /O *x75^ *
Sand bed dimensions //? *x *
Pressure Dist. Pipe Diam. / ^ *
Maniford Pipe Dlain. *
borrowed from site
(show location on site plan)*
trucked in
The undersigned hereby applies to the City of Orono for issuance of a septic system iiutallation
permit, agrees to do all work in strict accordance with the ordinances of the City and the
reg;ulations of the State of Minnesota, and certifies that all statements made on thb application
are complete, true and correct.
SignatureofApplicant: _____ Date; Co *~ I ?
MPCA Certification No.: C g? M O . • "
? •
Staff Review: Appro^
Reviewer:
Reason for Denial:
Date;