HomeMy WebLinkAbout1992-06-18 Application for Septic PermitAPPLICATION FOR SEPTIC SYSTEM PERMIT
CITY OF ORONO -7i
Box 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
General Instructions:
1. You may apply for peptic system permits by mail or in person at the
City offices. However, permits will not be mailed out and mus- be
picked up in person at the City offices.
2. Permits are not valid until you receive a permit card.
3. Work must nc.t begin unless the permit card is available on the jc'!-,
site.
4. Permits will be issued only to contractors ;,olaing a City of Orono
Septic System I staller'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 signo(' by
the City Inspector.
6. The f.11owing 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), and again during
pressure distribution pipinq installation in the rock h
d) Final inspection to verify proper final co -ot., and to
verify that all pump station (where require .,ponents are
functional and cu,mply with codes.
7. Individual holding bIPCA Installer Certificate shall be present during
installation. 24-hour notice is required for all inspections.
JOB SITE ADDRESS: _ G� �Q A V S C
Occupancy Type: Residential _�_ Commercial _ Other
Owner's Name: Phone: 47 s - 0 9/ g
Mailing Address: /p( So / '-' �fo.a,ow . i ty: 6.u4y2..,i,.- Zip: $53911
Septic Contractor's Name: .� �o �Jcr o S . Bus. Phone: 4Zo
Mailing Address: A( .�;-S/ �,��.r `06� ��, _ city: �.,pl r (rre�,�2 Zip: SS362
over -
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SEPTIC SYSTEM PERMIT APPLICATON -'PAG$ 2
Permit Type & F LLei� (check one)
Jjr/New Construction, Full System -$ S' G,
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
NOTE: Applicant must initial all spaces. Fill in all appropriate blanks.
check all appropriate boxes.
Initial
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 foAl�ing:
A. Tanks: Precast Concrete V Other Manufacturer Cu4L S
Tank Capacities: 1) 115o gal. 2) 100o gal. 3) gal.
B. Pump Station (if re uired)
Pump make & model E r - ��� �'`,6eL ( attach pump curve &
literature); system design requires gpm at 26� feet
of head. High water alarm make & model do #dy- Sc-,%eAW. r-k- .
trical work to be completed by _installer
electricia other Inside electrical work
mus a completed by electrician.
C. Treatment System:
Trenches: s.f. Mound
Depth of rock below pipe ro Rock bed dimensions 19'x '
Drop Boxes Sand bed dimensions 'x U'
Distribution Box Pressure Dist. Pipe Diam.A.5—r
Manifold Pipe Diam. /,S "
D. Final Cover/Topsoil to he: borrowed from site
(show .location on site plan
trucked in
The undersigned hereby applies to the City of Urono for issuanc4 of a
septic system installation permit, agrees to do all work in strict
accordance witr the ordinances of the City and the regulations of the State
of Minnesota, d certifies that all statements made on this application
are complete, true and correct.
Signature of Applicant: Date:
MPCA Certification No.: