HomeMy WebLinkAbout1996-06-22 Application for Septic Permit�� W
CITY OF ORONO SEPTIC SYSTEM PERMIT APPLICATION
Box 66 (2750 Kelley Parkway)
Crystal Bay, MIN 55323
JOB SITE ADDRESS:
Occupancy Type: Residential Commercial Other
Permit Type: New or Replacement System, $100.00
Repair Existing System, $ 50.00
(Tanks or Drainfield)
0.50 State surcharge added to above fees
*See fee schedule for non-residential permit fees
Owner's Name: ,Bohr. L&-Ic ir CIAs f.i%�� Phone Number: 90 L " /o (P a
Mailing Address: City: Tp:
Contractor's Name: „ e% f-Phone Number:
Mailing Address: City: gyp:
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.
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. Drainfreld 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 proper final cover depths and to verify that all pump station
(where required) components are functional and comply with codes.
5. Individual holding MPCA 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.
1. I have received a copy of the system design including the City of Orono
Septic System Approval Cover Sheet.
2. 1 will be installing the following: t,a�W�
A. Tanks: _ recast Concrete _ Other Manufacturer
Tank Capacities: 1) 13vo gal. 2) Ill gal. 3) jjgj)._ gal.
B. Pump Station (if required) C��e�
Pump make & model !. "Ji (attach pump curve &
literature); system design requires Aq gpm at I— feet of head.
Hish water alarm make & model AjkAc eim% Outside
electrical work to be completed by installer ./electrician
other Inside electrical work must be completed by
electrician.
C. Treatment System: r�
Trenches: s. f.Mound
Depth of rock below pipe Rock bed dimensions 1J 'xjze'
Drop Boxes Sand bed d mensioas3L_'xL'
Distribution Box Pressure Dist. Pipe Diam. its "
Maniford Pipe Diam.
D. Final Cover/Topsoil to be: borrowed from site
(show location on site plan)
WAS" - - ked 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.
SignatureofApplicant:` 91 4a�,ss-� Date: (i-22-5 a __
MPCA Certification No.:
Staff Review: Approval Z�;- Denial
Reviewer: MIR
Reason for Denial: