HomeMy WebLinkAbout1996-09-18 Application for Septic System PermitCITY OF ORONO
Box 66 (2750 Kelley Parkway)
Crystal Bay, MIN 55323
JOB SITE ADDRESS: / C, C C_`
SEPTIC SYSTEM PERI IIT APPLICATION
Occupancy Type: Residential �_ Commercial Other
Permit Type: New or Replacement System, $100.00
Repair Existing System, $ 50.00
(Tanks or Drainfleld)
0.50 State surcharge added to above fees
*See fee schedule for non-residential permit fees
Owner's Name: PhoneNumber: ,5J / 7 ad
Mailing Address: City: Z1F
Contractor's Name: ZLez- Phone Number: �/ 7 -V - / -le-_ -1
Mailing Address: City:
DO NOT MAEL PAYMENT WITH THIS APPLICATION
71RYFite►L INSTRUCTIONS
1. Applications for septic system permits may be trailed 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 prior to sand placement (sand will be jar tested for silt content),
1W 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 NiPCA 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.
y I. I have received a copy of the system design including the City of Orono
Septic System Approval Cove* Sheet.
2. I will be installing the following:
A. Tanks: Precast Concrete _ Other Manufacturer
Tank Capacities: 1) /%iG gai. 2) X:,,: gal. 3) i o gal.
B. Pump Station (if required)
Pump make & model L-2 /. (-, « pct_ (attach pump curve &
literature); system design requires_ pm 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:
Trenches:
Depth of rock below pi
Drop Boxes
Distribution Box
s. f. Mound
pe Rock bed dimensions /6 'x
Sand bed dimensions
Pressure Dist. Pipe Diam._"
Maniford Pipe Diam. " "
D. Final Cover/Topsoil to be: 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 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 correct.�j'
SignatureofApplicant: C Date:�A'
MPCA Certification No.:
Staff Review: Approval '�< Denial
A�5Reviewer: a/
Date: f
Reason for Denial: