HomeMy WebLinkAbout1995-07-25 Application for Septic PermitCITY OF ORONO SEPTIC SYSTEM PERMIT APPLICATION
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
JOB SITE ADDRESS: o2 TV —
Occupancy Type: Residential Lo""' Con4rprcial _ Other
Permit Type: f <w 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: &)4 •keys 4 Ass •c . PhoneNwnber:_ls '_
Mailing Address: a 3 0 11 ' City: Ed(-, RK".,t
Contractor's Name: ` " s Phone Number. .Y 7 s —174 Z
Mailing Address: sL x Sr2 . t• &7 • City: Ztp: 5S'3a
DO NOT MAEL PAYMENT WITH THIS APPLICATION
GENERAL INSTRUCTIONS
1. applications for septic syctpm perm. • , 3y be mailed or s0mitted in person at the City
Offices; however, per not Mailed out. The permit must be picked up in
person at the City Off- ork must not begin unf�;ss the permit car( ;s on the job
site.
2. Permits will be issued ordy 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 hw the "City of Orono Septic
System Approval" cover sheet signed by the City Inspector.
4. 'ollowing inspections will be required for all septir. -*ems:
,ire -installation site inspection to include inspector, inba and general contractor.
B. Tank installation prior to covering.
C. Drainfreld trench installation prior to covering. Foi _.,unds, inspection is required
after rough -up but prior to sand placement (sand will be jar tested for silt content),
again during pressure distribu. n piping installation in the rock bed.
D. Firal 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 durir:g j:.hVk,-ctkms. A 24-
hour nO.ke 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. I will be installing the following:
A. Tanks: _✓Precast Concrete
Tank Capacities: 1) 1pow gal
Calf
2) !a►d gal
Manufacturer
3) i•-v gal.
B. Pump Station (if required)
Pump make & model - 6J) AA0511 (attach pump curve &
literature); system design requires VV gpm at 1I? feet of head.
High water alarm make & model s S. Elgho Outside
electrical work to be completed by installer ✓ electrician
other Inside electrical work: must be completed by
electrician.
C. Treatment System:
Trenches: s.f. Mound
Depth of rock below pipe ock bed dimensions ,�' x Ste'
Drop Boxes Sand bed dimensions 31__' x !/ '
Distribution Box Pressure Dist. Pipe Diam. ja:"
Maniford Pipe Diam. z- "
D. Final Cover/Topsoil to be: borrowed from site
(show location on site plan)
X*L- 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 strict accordance with the ordinar_ces 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: e-g�Date: - L Y- it
MPCA Certification No.: g�
Staff Review: App a ual
Reviewer: -�> - - ." -
Date:
-
Reason for Denial:
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