HomeMy WebLinkAbout1995-06-16 Application for Septic System Permitv �
CITY OF ORONO SEP'T'IC SYSTEM PERMIT APPLICATION
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
JOB SITE ADDRESS: 7 3
Occupancy Type: Residential Commercial Other
Permit Type:
tepair
or Replacement System, $100.00
Existing System, $ 50.00
(Tanks or Drainfield)
0.50 State surcharge added to above fees
*See fee schedule for non-residential permit fees
Owner's Name: J � cC e -,k PhoneNumber. SS D -
Mailing Address: ICity: Ti:_
Contractor's Name: v .��^c PhoneNumber:_ -7 - 3-7/-f
�l
Mailing Address: 31 City:_ Tom: Ss� 74
DO NOT MAIL PAYMENT WITH THIS APPLICATION
GENERAL INSTRUCTIONS
1. Applications for septic system permits may be mailed or submitted in person at the City
Offices; however, permits will not be mailed out. The permit 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 "City of Orono Septic
System Approval" cover sheet signed by the City Inspector.
4. 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 prig 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 holding MPCA Installer Certificate shall be present during inspections. A 24-
hour notice is required for all inspections.
NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate
boxes.
�{�U _ 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: Y, Precast Concrete _
Tank Capacities: 1) I 3uD gal.
Other Manufacturer Pr_eGast Swf4-'
2) 13 cg a gal. 3) 1 Tw gal.
B. Pump Station (if required)
Pump make & modelge r5 1C YO (attach pump curve &
literature); system design requires 3 ct gpm at 2-0 of head.
High water alarm make & model 64,.� Outside
electrical work to be completed by installer electrician X
other Inside electrical work must bf zompleted by
electrician.
C. Treatment System:
Trenches: s. f. � Mo;and
Depth of rock below pipe Rock bed dimensions 10 'x
Drop Boxes Sand bed �- :mensions q_? 'x /01('
Distribution Box Pressure Dist. Pipe Diam. 1-4- "
Maniford Pipe Diam. Z
D. Final Cover/Topsoil to be: borrowed from site
(show location on site plan)
trucked in
The undersigned hereby app . to the City of Oror. ,suance of a septic system histallation
permit, agrees to do all work in strict accorda._�.e �i the ordinances of the City and the
regulations of the State of Minnesota, and certifies that all statements made on this application
are c Clete, true and correct.
SignatL_ Applicant: G� /� ✓&�n= Date: .4'/ Z - ce S -
MPCA Certification No.:
Staff Review: Approval !/ Denial
Reviewer: Date: /—/57-9S _
Reason for Denial: