HomeMy WebLinkAbout1994-06-14 Application for Septic PermitCITY OF ORONO
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
JOB SITE ADDRESS: 0.5-6 Ca,c F IQ�I
Occupancy Type: Residential ✓
New or Replacement System,
Repair Existing System,
0.50 State surcharge added to above fees
*See fee schedule for non-residential permit fees
Owner's Name: T C PhoneNumber. YL y -38 7-
Mailing Address: City: Zips
Contractor's Name: Pbone Number: 4 71-
Mailing Address: 26 3 City: �,,,, . sr Tip:
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.
All work must be done in accordance with the approved septic sysL a design. Design
reports are not considered approved unless accompanied by the "City of Orono Septic
System Approval" cover sheet signed by the City Inspector.
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),
_4W 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.
Individual holding MPGA Installer Certificate shall be present during inspections
hour notice is required for all inspections.
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:
A. Tanks: _ Precast Concrete _ Other Manufacturer
Tank Capacities: 1) gal. 2)1 r , gal. 3) /� gal.
B. Pump Station (if required) We osil .
Pump make & model % �6o /Y (attach pump curve &
literature); system design requires 3?'_ gpm at H feet of head.
High water alarm make & model L-- e / 4 R m Ou de
electrical work to be completed by installer - electricians
other Inside electrical work must be completed by
electrician.
C. Treatment System:
Trenches: s.f. Mound
Depth of rock below pipe Rock bed dimensions /e7 'x Sb'
Drop Boxes Sand bed dimensions fz- 'x_2;2-'
Distribution Box Pressure Dist. Pipe Diem.
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 ui the State of Minnesota, and certifies that all statements made on this application
are complete, true and correct.
SignatureofApplicant: Date: to
MPCA Certification No.: T i Z
Staff Review: Approvpl v Denial
Reviewer: Date:
Reason for Denial: