HomeMy WebLinkAbout1989-10-23 Application For Septic Permit4-
APPLICATION FOR SEPTIC SYSTM PERMIT
CITY OF OaONO
Box 66 (1335 So Bros Rd)
Crystal Day, MM 55323
General Instructions:
1. You may a1yy for septic system permits by mail or in person at the
City offer. Nowever, 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.
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 =the rock bed.)
d) final inspection to verify proper final cover depths and to
verify that all pump station (where requirtr ) components are
functional and comply with codes.
7. Individual holding MPCA Installer Certificate shall be present during
all inspections. 24-hour notice is required for all inspections.
JOB BITS ADDRS88s %ys _Z/� c / -, /t :2,`I'
Occupancy Types Residential ` Commercial Other
Owner's Hame: .,o Phone: ,/?9 - Id �
Mailinq Address: �f4j- 'r 1L/6-�-1•,k z-r City: -•Z- Zip: 3`
Septic Contractor's Name: 1.ez L �.a !� Bus. Phone:��1
Mailing Address: l City: % �Z�� Zip:.5���7'
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SEPTIC SYSTEM PERMIT APPLICATOR - PAGE 2
Permit Type s Fees (check one)
New Construction, Full System $75.00. . . . . . . . . . . . . .
Replace Existing System (1 or more new tanks & 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 ROT MAIL PAM= MITE THIS APPLICATIOR
ROTE: Applicant must initial all spaces. Fill in all appropriate blanks,
check all appropriate boxes.
Initial
�i.
I have received a copy of the system design including the
City of Orono Septic System Approval Cover Sheet.
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2. I will bestalling the following: �--
A. Tanks: �pprecast Concrete Other Manufacturer ' 4*_e_4!-+v
Tank Capacities: 1) a�qal. 2) /�*�J gal. 3) gal.
B. Pump Station (if required)
Pump make i model _, - L (attach pump curve :
literature); syst sign requires mat //� feet
of head. High water alarm make i mo a L•-«
out electrical work to be completed by —installer
Le'electrician other Inside electrical work
must be completes by a ectr c an.
C. Treatment System:
Trenches: s.f. �und
Depth of rock -bed pipe " Rock bed dimensions''
Drop Boxes Sand bed dimen:iam.
ions x'
Distribution Box Pressure Dist.Pipe am."
Manifold Pipe I,�Z
D. Final Cover/Topsoil to be: 1L -borrowed from site
/ (show location on site plan)
l 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.
,1 ,
Signature of Applicant: �' C''t ` Date:
MPCA Certification No.: ij