HomeMy WebLinkAbout1993-10-25 Application for Septic PermitAPPLICATION FOR SEPTIC SYSTEM PERMIT
CITY OF ORONO
Box 66 (1335 So Brown Rd)
Crystal Bay, NN 55323
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General Instructions:
1. You may aoo 1 for septic system permits by mail or in person at the
City offices. However, permits will not be mailed out and must be
picked up in person at the City offices.
2. Permits are not valid until you receive a permit card.
3. Work must not begin unless the permit card is available on the job
site.
4. Permits will be issued only to contractors holding a City of Orono
Septic System Installer's License.
S. 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.
6. 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), 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.
7. Individual holding MPCA Installer Certificate shall be present during
installation. 24-hour notice is required for all inspections.
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JOB SITE ADDRESS: X0 &41 A&'
1ccupan cy Type: Residential GZ Commercial Other
Owner's Name: C.Sd`_
Phone : 41101
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Mailing Address: 2 3 53
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City:
Zip: f!!f!
Septic Contractor's Name:
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V Bus.
Mailing Address: �_)C
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City: L-c -r-f%
Zip: tifh
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.EPTIC SYSTEM PERMIT APPLICATON - PAGE 2
/ Permit Type & Fees (check one)
y1 New Construction, Full System $100.00 . . . . . . . . . . . .
Repair or Replace Existing System $50.00. . . . . . . . . . . . .
0.50 State surcharge added to above permit fees
SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES
DO NOT !SAIL PAYMENT WITH THIS APPLICATION
30TE: Applicant must initial all spaces. Fill in all appropriate blanks,
check all appropriate boxes.
Initial
1. I have received a copy of the system desigi including the
City of Orono Septic System Approval Cover Sheet.
2. I will be *"talling the following:
A. Tanks: ci, Precast Concrete Other Manufacturer
Tank Capacities: 1) 1250 gal. 2 ) 1000 gal. 3 ) j1s4 gal.
B. Pump Station (if required)
Pump make & model w1rc, (attach pump curve &
literature); system design requires a gpm at feet
of h ad. High water alarm make & mo el DL !�
Ou side electrical work to be completed by installer
_electrician other Inside electrical work
must be completed by electrician.
C. Treatment System:
Trenches: s.f.
Depth of rock below pipe "
Drop Boxes
Distribution Box
Mound
Rock bed dimensions/0 'x_Lf
Sand bed dimensions ='x_L
Pressure Dist. Pipe Diam."
Manifold Pipe Diam. 2
Final Cover/Topsoil to be: _borrowed from site
(show location on site plan)
trucked in
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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.
Signature of Applicant: ,,.� i��x�.,,c �„�. Date: /0 aI 2 z_
_SPCA Certification No.: %(J o