HomeMy WebLinkAbout1995-06-12 Application for Septic System PermitCITY OF ORONO SEFfIC SYSTEM PERMIT APPLICATION
Box 66 (2750 Kehdy Parkway)
Crystal Bay, MN 55323
JOB SITE ADDRE&i: Z- / b 0 S ' 4 & -
Occupancy Type: Residential_ Commercial Other
Permit Type: Cew r Replacement System, $100.00
Repair Existing System. $ 50.00
(Tanks or DrainAeld)
0.50 State surcharge added to above fees
*See fee schedule for non-residential permit fees
Owner's Name: G i ret cv PlaneNumber:
Mailing Addt ess• City: ?1p:
Contractor's Nam?': �, ,nJ Cr Hill Lu 17P---- PhoneNumber:
Mailing Address:l c fe /}w E _ City:�kTL 7� =S 7
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DO NOT MAIL PAYMENT WITH THIS APPLICATION
GENERAL INSTRUCTIONS
1. Applications for septic system permits may be mailed c'; submitted in person at ►ric City
Offwf;-�, however, permits will not be matted out. Tic perrnit must be picked up in
perscn at the City Offices and work must not b-egsas ice+ the permit card :s on the job
site.
2. Permits will be issue I only tc contractors holding a City o: Orono Septic System
Installers License.
3, , 11. work must be done in accordance with the approve. =:-ptic system design. Design
,reports a:e not considered approved unlesq-scnmpanied by the "City of Orono Septic
System Approval" cover sheet signed by the Inspector.
4 The following inspections will be required for ali r .• is systerr^
A. Pre -installation site inspection to include inspe.tor, installer, asp gen_rai contractor.
B. Tank installation prior to cuvering.
C. Drainfreld trench installation prior to cover' For mourns, inspection is required
after rough -up but prior to sand placement will be jar tested for silt content),
and again during pressure distribution piping installation in the rock bed.
D. Final inspectir•. w verify rcoper final cover depths arc+ to verify that Al pump station
(where required) cotnponeats ^re ` ,nctional and cc with codes.
5. Individual holding MPCA Insta..- tificate shall be present during inspections. A 24
Wir notice is ::squired for all inspections.
NOTE: Appli(.alit must initial all spaces. Fill in all appropriate blanks, check all appropriate
boxes.
/f A,)— 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: &4e—� SA. Tanks: (( Precast ConLrete Other Manufacturer YZ'
Tank Capacities: 1) 1 '-W dal. 2) (acv gal. 3)1 3w gal.
B. Pr_mp Station (if required)
Pump make & model M -,r" h4::5 qO (attach pump curve &
literature); system design 4quires '% ct_ gpm at I X— feet of head.
High water alarm make & model AA YG -s — Outside
electrical work to bP 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: _
k Mound
Rock bed dimensions (t'x a '
Sand bed dimensions 4
Pressure Dist. Pipe Diam. t yL "
Manifc Npe Diam. -L- "
:owefj from site
,:ow location on site plan)
u ucked in
The unders:aned hereby applies to the City of Orono for issuance of a septic system insWlation
permit, agrees to do all work in strict accordance with the ordinances of the Cit;. aad the
regulations of the State of Minnesota, and certifies that all statements made on this application
are complete, true and correct.
SignatureofApplic% pijo OC Date: toZ'?-)
MPCA Certification No.:
Staff Review: Approval Denial
Reviewer: Date:
Reason for Denial: