HomeMy WebLinkAbout1991-09-10 Application for Septic System PermitAPPLICATION FOR SEPTIC SYSTEM PERMIT`/ .i
CITY OF ORONO
Boz 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
General Instructions:
1. You may SPIX for septic system permits by mail or in person at the
City offices. However, permits will not be mailed out and must be
picked up in person at the City offices.
2. Permits are not valid until you receive a permit card.
3. Work must not begin 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 by 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 s,
a) Pre -installation site inspection to include inspector, al,ler,
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), and again during
pressure distribution piping installation in the rock bed.
d) Final inspection to verify r-oper final cover depths and to
verify that all pump stati+ where required) components are
functional and comply with co-,:4:,i.
7. Individual holding MPCA Installer Certificate shall be present during
installation. 24-hour notice is required for all inspections.
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JOB SITE ADDRESS: 3 / �_ / ✓,-, /.,,; -
Occupancy Type: Residential Commercial Other
Owner's Name: Phone:
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Mailing Address: /Sri-cs �v� /�,- �. City:zz o Zip: 5�5'3 s G
Septic Contractor' s Name: ;cl /A 4,, ; c r s ?.,�, _ Bus. Phone ve/7f v
Mailing Address: �l>Gy H%µ.,ye w� 5��. City:' Zip: syr<e3
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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2
Permit Type & % ees (check one)
ew Construction, Full System $75.00. . •. . . . . .
Replace Existing System (1 or more new tanks &drainfield) $50.00. . .
Partial Replacement (replace just tanks or just drainfield) $30.00. . .
$0.50 State surcharge added to above permit fees
SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES
DO NOT MAIL PAYMENT WITH THIS APPLICATION
MOTE: Applicant must initial all spaces. Fill in all appropriate blanks,
check all appropriate boxes.
Initial
ir<� 1. I have received a copy of the system design including the
City of Orono Septic System Approval Cover Sheet.
2J--'r- 2. I will b installing the following:
A. Tanks: Precast Concrete Other Manufacturer
Tank Capacities: 1) gal. 2) gal. 3) gal.
B. Pump Station (if required)
Pump make & model (attach pump curve &
literature); system design requires gpm at feet
of head. High water alarm make & model
Outside electrical work to tv completed by _installer
electrician other Inside electrical work
must be completed by electrician.
C. Treatment System:
Trenches: s. f .
De th of rock below pipe 1 2 "
Drop Boxes
Distribution Box
Mound
Rock bed dimensions 'x '
Sand bed dimensions 'x_ '
Pressure Dist. Pipe Haw, "
Manifold Pipe Diam.
D. Final Cover/Topsoil to be: )< borrowed from site
(show location on site plan)
trucked in
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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.
Signature of Applicant: �i' /li�1+r- Date:
MPCA Certification No.: 7 7,1?'