HomeMy WebLinkAbout1989-07-31 Application for Septic System PermitAPPLIC.ITIOH FOR SEMC SZSTSM PIM T
CITY OF ORONO
Box 66 (1335 So Brown Rd)
Crystal Bap, MA 55323
General Instructions:
1. You may accly for septic system permits by mail or in person at the
City off ces. However, permits will not be mailed out and must be
picked up in person at the City offices.
2. pe--its 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 oily to contractors holding a City of Orono
Septic System Installer's License.
5. 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, 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 wi•_': codes.
7. Individual holding MPCA Installer Cert�.:°cate shall be present during
all inspections. 24-hour notice is required for all inspections.
JOB SITE ADDRESS: S-7C A l • r I fZ y1 Ze- c
Occupancy Type: Residential Commercial Other -
Owner I s Name: r, Phone:
Mailing Address: City: Zip:5-r Tqf_
Septic Contractor's Name: , 1e;� j, S �- .1 c r S+ c • Bus. Phone
.sailing Address: }J City: Zip:—,,;1Cqo_
- over -
SEPTIC SZSTZK PMtMIT APPLICATOR - PAGZ 2
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Permit Type : Fees (check one)
New Construction, Full System $75.00. . . . . . . . . . . . . . . . . .
Replace Existing System (1 or more new tanks i drainfield) $50.00. . .
Partial Replacement (replace just tanks or just drainfield) $30.00. . .
$0.50 State surcharge added to above permit fees
SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES
' DO WT KAIL PAIIMT WITH THIS APPLICATION
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XOTZz Applicant must initial all spaces. Fill in all appropriate blanks,
check all appropriate boxes.
initial
1. I have received a copy of the system design including the
cc .City of Orono Septic System Approval Cover Sheet.
L� 2. I will be installing the following:
A. Tanks: Precast Concrete Other Manufacturer
Tank Capacities: 1) tOQn gal. 2 ) /pa.? _gal. 3 ) 1C.�y gal.
B. Pump Station (if required)
Pump make i model p��,,,,/, ,.,s SE41i (attach pump curve
literature) ; system design requires gpm at I'll 2 feet
of head. High water alarm make t model ---�`
Outside electrical work to be completed by _)Snstal er
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/a_'xc'
Drop Boxes Sand bed dimensions
Distribution Box Pressure Dist. Pipe
Manifold Pipe Di_
D. Final Cover/Topsoil to be: borrowed from site
(show location on site plan)
trucked in
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he undersigned hereby applies to the City of Orono for issuance of a
optic system installation permit, agrees to do all work in strict
:cordance with the ordinances of the City and the regulations of the State
Minnesota, and certifies that all statements made on this application
=e complete,. true and correct.
:gnature of Applicant: ��— Date: -31 - L,
'CA Certification No.: ?� Q'