HomeMy WebLinkAbout1996-05-28 Septic Repair Permit ApplicationCITY OF ORONO SEPTIC SYSTEM PERMIT APPLICATION
Box 66 (2750 Kelley Parkway)
Crystal Bay, tiIN 55323
JOB SITE ADDRESS: LI s N",+Li V) 044P
Occupancy Type: Residential � Commeri ial Other
Permit Type: `ew $100.00
(Repair E. in Svstem $ 50.00
(Tanks afield)
0.50 State surcharge added to above fees
*See fee schedule for non-residential permit fees
Owner's Name: J e-�- �A �}(� \der Phone Number:
Mailing Address: ySs lVo.-++. City: 0V0&1& Tp:y —
Contractor's Name: ✓ , s Lt 4, Li PhoneNumber: 1173 -4i 3d U
INIailing Address: 01 `Cz City: Tp: ,
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 muL _ 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),
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.
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 ' ,',.eet.
I will be installing 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 completed by
electrician.
C. Treatment System:
Trenches: s. f. Mound
Depth of rock below pipe Rock bed dimensions _'c 2 '
Drop Boxes Sand bed dimen6ons �ia�m�'
xDistribution Box Pressure Dist. pipe D
Maniford Pipe Diam. f'� "
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 thy'
regulations of the State of Minnesota, and certifies that all statements made on this application
are complete, true and correct.
Signature of Applicant:_
MPCA Certification No.: r-�U
Staff Review: .:ppro v Denial a f
Reviewer: Date:
Reason for Denial: