HomeMy WebLinkAbout1995-10-25 Application for Septic System PermitCITY OF ORONO
Bok 66 (27S0 KeUey Parkway)
Crystal Bay, MN 55323
SEPTICSYSTEM PERMIT APPUCATION
JOB SITE ADDRESS: ^ ^
Occupancy Type: Residential _)(
Permit Type:
Commercial Other
New or Replacement System, $100.00
Repair ExiRing System, $ 50.00
(Tanks or Drainfiehl)
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0.50 State surcharge added to aboee fees
*See fee schedule for non-residentlal permit fees
Owner’s Name: /^>
Mailing Address:
VffVBifPAOMtnuCUtr's Name:____
Mailing Address: Cok
PhoneNianbcr:
City:.
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City:
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DO NOT MAIL PAYMENT WITH THIS APPUCATION
CTWRUAI. 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 syst^‘’=* design. Design
reports are not considered approved unless accompanied by the ”C A 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. 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).
iOd 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 presemduring inspections. Aid-
hour notice is required for all inspections.
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; .
NOTE: Applicant must initial all qwces. FiU in aM appropriate blanks, check aM appropriate
boxes.
ytfs 1. 1 have received a copy of the system design including the City of Orono
Septic System Approval Cover Sheet.
yes 2. 1 wUl be ins^ing the followiiig:
A. Tanks: 3 Precast Concrete Other Manufacturer
Tank Capacities: 1) /?U^ gal. 2) gal. 3) gal*
^ -iO (attach pi^ cun^
literature); system desip requires _ ffl>m at_____feet Outside
installer____electrician V
Hip water alarm make & model
electrical work to be completed by-------------------- ------
other __________• electrical work must be completed by
electrician.
C. Treatment System:
Trenches:s.f.
Depth of rock below pipe
____Drop Boxes
____Distribution Box
X Mound
Rock bed dimensions / Q *x b* *
Sand bed dimensions l^o *x ¥L*
Pressure Dist. Pipe Diam. Jjxj'
Maniford Pipe Diam. X- "
D. Final Cover/TopsoU to be: K 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 stria accordance with the ordinances of the City and the
t^ulations of the State of Minnesoto. and certifies that aU statements made on this application
are complete, true and correct.
Dme: /D-ZS'^f^ tl QJl^
MPCA Certification No.:.^_______
Staff Re»few! Approval Denial
A' / IReviewer:Ym Date:
Ream far Denial:.