HomeMy WebLinkAbout1995-07-25 Application for Septic Permit.?i-7 7
CITY OF ORONO SEPTIC SYSTEM PERMIT APPLICATION
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
JOB SITE ADDRESS: C L_9 fU D.41 1i.111 a:(Z .
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: 4 Sc� «.�t� L _ PhoneNumber'. 174 - 6 7 6 S
*tailing Address: 41k.,,4,44 .4.,. City: w4%r-4rA-- Z1p; 1EL1f,
Contractor's Name: 3j: Sr. % PhoneNumber.yW—/7` -z_
Mailing Address: %old /fth 4.6 %A City:/ &% f►W 731x 11a 3
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 ae-!' 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 ir. accordance with the approvP-' rystem design. Design
reports are not considered approved urdess "City of Orono Septic
System Approval" cover sheet sign'
4. The following insr ctions will be req,
A. Pre -installation Site inspection to in. L"��U1 general contractor.
B. Tank installation prior to covering.
C. Drainrield trench installation prior tc , aspection is required
after rough -up but prior to sand piact ... ce jar tested for silt content),
&Ud again during pressure distribution �...g installation in the rock bed.
D. Final inspection to verify pror. . final cover depths and to verify that all pump station
(wf_;; required) components are functional Ind comply with codes.
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. I will be installing the following:
A. Tanks: _✓Precast Concrete _ Other Manufacturer
Tank Capacities: 1) LLtL gal. 2) gal. 3) Zf,20 gal.
B. Pump Station (if required)
Pump make & model 62dd wed S:/1 (attach pump curve &
literature); system design requires 36 gpm at 31, feet of head.
High water alarm make & model ' 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. Mound
Depth of rock below pipe Rock bed dimensions /'x ci'
Drop Boxes Sand bed dimensions -V_'xA_'
Distribution Box Pressure Dist. Pipe Diam. ys "
Maniford Pipe Diam. -_"
D. Final Cover/Topsoil to borrowed from site— sh t kP dg
(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 strict accordance with the ordinances of the City and the
regulations of the State of Minnesota, and certifies that a)1 statements made on this application
are complete, true and correct. 14
SignatureofApplicant:
MPCA Certification No.:
Staff Review: Appr Val �' Denial
Reviewer: — Date:--ZA—�
Reason for Dt--su.!: