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HomeMy WebLinkAbout1994-08-24 Application for Septic PermitU r V OF ORONO SEPTIC SYSTEM PERMIT APPLICATION B%x 66 (2750 Kelley Parkway) CrsW :3ay, MN 55323 JOB SITE ADDRESS: SAr Occupancy Type: Residential /_ Commercial Other Permit Type: New or Replacement System, $100.00 ✓ Repair Existing System, $ 50.00 0.50 State surcharge added to above fees 'See fee schedule for non-residential permit fees Owner's Name: Ni.'t C- �y 1az PhoneNumber: Mailing Address: 5 SO City: Q. a .^w 21p: Contrador's Name: 'f PbomeNunba: tip{ g- [ 7G Mailing Address: H 7 tro ce R.J i o E City: C/as k.. 23p;S -S& DO NOT MAIL 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 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 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 mounds, inspection is required after rough -up but prior to sand placement (sand will be jar tested for silt content), 11W 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 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 AAM w ; v- Tank Capacities: 1) 12 So gal. 2) /:a gal. 3) gal. B. Pump Station (if required) Pump make & model (attach pump curve & literature); system design requires gpm at feet of head. High water alarm make & model 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 of Rock bed dimensions I'x,&L' Drop Boxes Sand bed dimensions 9_q_'x Sl ' Distribution Box Pressure Dist. Pipe Diam. . r, Maniford Pipe Diam. D. Final Cover/Topsoil to be: 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 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. SignatureofApplicant: — % - Date: I MPCA Certification No.: / ? as Staff Review: Approv -�7'1—" al Reviewer: Date; Reason for Denial: CITY OF ORONO SEPTIC SYSTEM PERMIT APPLICATION Box 66 (2750 Kelley Parkway) ,Z Crystal Bay, MN 55323 JOB SITE ADDRESS: S SD e.., s f Ao" It i.-kc Rd Occupancy Type: Residential ✓ Commercial Other Permit Type: New or Replacement System, $100.00 Repair Existing System, $ 50.00 0.50 State surcharge added to above fees *See fee schedule for non-residential permit fees Owner's Name: PhoneNumber: Mailing Address: City: ZIP Contractor's Name: i O•Ls•'� _s__ � PboneNumber: y Yr- x / 7& Mailing Address: yg o !t /o F_ City: CJack., ZIP5'EW DO NOT MAIL 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 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 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 mounds, inspection is required after rough -up but prior to sand placement (sand will be jar tested for silt content), 1W 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 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 Systear Approval Cover Sheet. 2. 1 will be install' the following: A. Tanks: ✓ Concrete _ Other Manufacturer Tank Capacities. 1) gal. 2) gal. 3) gal. B. Pump Station (if ired) Pump make & mod (attach pump curve & literature); system d requires gpm at feet of head. H; .h water alarm & model Outside electrical work to be co m leted by installer electrician other ide work must be completed by electrician. C. Treatment System: Trenches: s.f._ Mound Depth of rock below pipe Rock bed dimensions LQ_'r.�Z' Drop Boxes Sand bed dimensions }k'x�' Distribution Box Pressure Dist. Pipe Diam. I -- �►�ianiford Pipe Diam. 2 D. Final Cover/Topsoil to be: ✓ bo wed from site ( w location on site plan) truck in The undcrsigned hereby applies to the City of Oro for issuance or a on permit, agrees to do all work in strict accorda with the ord%nances of the City and the regulations of the State of Minnesota, and certifies that all statemet4s made on this application are complete, true and correct. SignatureofApplicant: - Date: ! x Y7 9 N MPCA Certification No.: 13 A S Staff Review: Approval Denial Reviewer: Reason for Denial: Date: CITY OF ORONO SEPTIC SYSTEM PERMIT APPLICATION Box 66 (2750 Kelley Parkway) 3 Crystal Bay, MN 55323 JOB SITE ADDRESS: S Sa 1C.�j Occupancy Type: Residential ✓ Commercial Permit Type: New or Replacement System, $100.0p Repair Existing System, $ 50.00 0.50 State surcharge added to above fees *See fee schedule for non-residential permit fees f Owner's Name: PhoneNumba: Mailing Address: City: TJpc Contractor's Name: Phonerumbe: 4 Yr- 217G Mailing Address: 4 4 ro g 1 t o e: City: L f �_ 2%z. ` ►. DO NOT MAIL PAYMENT WITH THIS APPLICATION GENERAL INSTRUCTIONS 1. Applicatiowe 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. 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 mounds, inspection is required after rough -up but prior to sand placement (sand will be jar tested for silt content), 1W 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 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 syste;n design including the City of Orono Septic System Approval Cover Sheet. 2. I will be mstalI)nS the following: A. Tanks: �/ Precast Concrete _Other Manufacturer ��:.� Tank Capacities: 1) gal. 2) gal. 3) gal. B. Pump Station (if required) pump make & model (attach pump curve & literature); system design requires gpm at feet of head. High water alarm make & model . Outside electrical work to be completed by installer electrician other Inside electrical work must be by electrician. C. Treatment System: Trenches: s.f 10- .13 Mound Depth of rock below pipe Rock bed dimensions L'x XT' Drop Boxes Sand bed dimensions '�L'x__' Distribution Box Pressure Dist. Pipe Diam. Maniford Pipe Diam. D. Final Cover/Topsoil to be: ✓ borrowed from site (show location on site plan) tricked in The undersigned hereby applies to the City of septic system installation permit, agrees to do all work in strict accordiftCe with the ordinances of the City and t' regulations of the State of Minnesota, and certifies that all statements made on this applicati. are complete, true and correct. Signatureof Applicant: MPCA Certification No.: Staf Review: Approval Reviewer: Reason for Denial: f Denial �j Date: 8'