HomeMy WebLinkAbout1990-08-06 Application for Septic PermitAPPLZCATZOH FOR SEPTIC SYSTEM PERMIT
CITY OF OROMO
Box 66 (1335 So Broim Rd)
Crystal Bay, MM 55323
General Instructions:
1. You may apply for septic system permits by mall or In person at the
City offices. However, penlts will not be nailed out and nuat be
picked up in person at the City offices.
2.
3.
Permits are not valid until you receive a permit card.
Work must not be^in 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.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.
6.The following inspections will be. required for all septic systems:
a) Pre-installation site inspection to include inspector, installer,
and general contractor.
b)
c)
Tank installation prior to ^nvering.
Drainfield trench installation prior to covering. (For mounds,
inspection is required after rough-up but prior to sand
placement, and again daring pressure distribution piping
installation in the rock bed.)
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
all inspections. 24-hour notice is required for all inspec'^ions.
JOB SITE JUIDRBSSs
Occupancy Type: Residential )(
Owner's Na. Lc >
Commercial
kU;1\
_ Other .
iA A L - ^
Mailing Addres<City:Zip:
Septic Contractor's Name:4^ > Bus. Phone:
Nailing Address: ^ '21C-- Citvt5#Si*^536^
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SBPTIC SYSTEM PERMIT APPLICATOR - PAGE 2
Peznit Type ft Fees (check one)
New Constructionp Full System $75.00. . . . . . . . . . . . . . . .
Replace Existing System (1 or more new tanks ft dralnfleld) $50.00
Partial Replacement (replace just tanks or just dralnfleld) $30.00. • .
• • e
$0.50 State surcharge added to above permit fees
SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES
DO MOT MAIL PAYMENT WITH THIS APPLICATION
NOTE: Appllr:. must initial all spaces. Fill in all appropriate blanks,
check al^ 4ppropriate boxes.
Initial
1.ecelved a copy of the system design including the
Orono Septic System Approval Cover Sheet.
2.
A.
I V
Tanksr
*)e installing the following:
^Precast Concrete Other Manufacturer
Tank Capacities ? 1)
^ \ I'S
/tcc^^gal. 2) gal. 3) /25to
B.Piamp Station (if required)
Pump make ft model 6c./
gal.
K L____________________tattach pump curve ft
literature ); system design requllrea —^7 cnsm at feet
of head. High water alarm make ft model L^tyJAi^tn
Outside electrical work to be completed by install^
A^lectriclan __other____________. Inside electrical wOi.A.
must be completed by electrician.
C.Treatment System:
Trenches:s.f.
Depth of rock below pipe
Drop Boxes
Distrl Ion Box
D. Final Cover/Topsoil to be: X
X Mound
Rock bed dimensions /o *x 6^*
Sand bed dimensions^/' *
Pressure Dlst. Pipe Dlam. /A. *
Manifold Pipe Diam. >2 ^ ^
borrowed from site-^T^-^^v>».
(show location on slte^lafi)c/r^
_ _ trucked in » /
****«*«***********e***<**y >*****•*•#*•**#••••**••*#*•#*****•*♦**••♦•♦*•♦**♦• / /
The undersigned hereby applies to the City of Orono for Issuance of a t?
septic systeti. Installation permit, agrees to do all work in strict
accordance with the ordlnani of ihe City and the regulations of the State
of Minnesota; and certifl'v^ ciiat oil statements made on this application
are complete,, true and correct.
Signature of Applicant:,
MPCA Certification No.:
6?. M
V9-/\
Date; ^
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