HomeMy WebLinkAbout1991-06-17 Septic System Permit ApplicationAPPLICATION FOR SEPTIC SYSTEM PERMIT 3
CITY OF ORONO
Boz 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
General Instructions:
1. You may apply for septic system permits by mail or in person at the
City offices. However, permits will not be mailed out and must be
picked up in person at the City offices.
2. Permits are not valid until you receive a permit card.
3. Work must not begin unless the permit card is available on the job
site.
4. Permits will be issued only to contractors holding a City of Orono
Septic System Installer's License.
5. A 1 1 work must be done in accordance with the approved septic system
design. Design reports are not considered approved unless accompanied
by the "City of Orono Septic System Approval" cover sheet signed by
the City Inspector.
6. 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 mounds,
inspection 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.
7. Individual holding MPCA Installer Certificate shall be present during
installation. 24-hour notice is required for all inspections.
JOB SITE ADDRESS:
Occupancy Type: Residential ✓ Commercial Other
Owner's Name: Phone: ":Z_ y/
Mailing Address: aii�y�.�.•�J.�k�� �����<<.��c,itY: c:haUo Zip:
Septic Contractor's Name: PA&ek�„�g CLPXQ, Bus. Phone:
Mailing Address:/;�s `lam w �5i City:
over -
SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2
Permit Type i Pees (check one)
New Construction, Full System $75.00. . . . . .
Replace Existing System (1 or more new tanks & drainfield) $50.00. .
Partial Replacement (replace just tanks or just drainfield) $30.00. . .
$0.50 State surcharge added to above permit fees
SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES
DO NOT MAIL PAYMENT WITH THIS APPLICATION
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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: j�
A. Tanks: precast Concrete Other Manufacturer l&C
4��a�
Tank Capacities: 1) j2CT) gal. 2)�gal. 3) gal.
B. Pump Station (if required)
Pump make & model _ (attach pump curve &
literature); system design requires gpm at feet
of head. High water alarm make & model
Outside electrical work to be completed by _installer
electrician other Inside electrical work
must be completed by electrician.
C. Treatment System: e, •%O`
Trenches: s.f. Mound
Depth of rock below pipe Rock bed dimensions _'x '
drop Boxes Sand bed dimensions 'x '
Distribution Box Pressure Dist. Pipe Dian. "
Manifold Pipe Diam. "
D. Final Cover/Topsoil to be: borrowed from site
(show location on site plan)
trucked in
The undersigned hereby applies tc the City of Orono for issuance of a
septic system installation permit, agrees to do all work in strict
accordance with the ordinances of the City and the regulations of the State
of Minnesota, and certifies that all statements made on this application
are complete, true and c e 7
Signature of Applicant w �-�-� Date:
AP
MPCA Certification No.: