HomeMy WebLinkAbout1995-08-03 Application for Septic System Permit4
1
CITY OF ORONO
Box 66 (2750 Kelley Parkway)
Crystal Bay, MIN 55323
JOB SITE ADDRESS: 2 y
SEPTIC SYSTEM PERitiIIT APPLICATION
104fen
uAv
Occupancy Type: Residential lol� 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: (V4 (;,rL _�_JAt e- j� ; S Phone Number: '3c? `i - - 7570
Mailing Address: Z : w City: T1p:.SS 3�7
Contractor's Name: AT- Z,* 4e- toS Phone tunber: 4/7[r- 73 93
Mailing Address: 23 20 o (O Cl IV -Au - &l. City: oCft-1 S Tip: SS37
DO NOT MAEL 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 'y 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. Drainfield trench installation prior to covering. For —ands inspection is required
after rough -up but prior to sand placement (sand i r tested for silt content),
and again during pressure distribution piping instaij the rock bed.
D. Final inspection to verify proper final cover depL!--q an, y that all pump station
(where required) components are functional and comp =odes.
5. Individual holding MPCA Installer Certificate shall be present ring 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 Or
Septic System Approval Cover Sheet.
2. I will be tailing the following:
A. Tanks Precast Concrete _Other Manufacturer
Tank Capacities: 1)12-50 gal. 2) (pro gal. 3) (ZSo gal.
B. Pump Station (if required
Pump make & model S �r - 'Uff- Su% (attach pump curve &
literature); system design requires _ qQ_ gpm at Z'� `eet of head.
High water alarm make & model .� &-;Z 'f • • Outside
electrical work to be completed by installer electrician
other Inside electrical work must be completed by
electrician.
C. Treatment System:
Trenches: s.f. zl Mound
Depth of rock below pipe Rock bed dimensions -&-'xG'
Drop Boxes Sand bed dimensions 5-
Distribution Box Pre :sure Dist. Pipe Diam. `
Maniford Pipe Diam. Z.
D. Final Cover/Topsoil to be: —Y— 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 ork in strict accordance with the ordinances of the City and the
regulations of the State Minnesota, and, certifies that all statements made on this application
are complete, true and c •ect
SignatureofApplicant: Date:
MPCA Certification No.: a
Staff Review: Approval Denial
Reviewer: pl �---� Date:
Reason for Denial:_