HomeMy WebLinkAbout1997-05-01 Application for Septic System PermitA 2-
CITY OF ORONO SEPTIC SYSTEM PERMIT APPLICATION
Box 66 (2750 Kelley Parkway)
Crystal Bay, MN 55323
JOB SITE ADDRESS: 76, 3 Fe rptc ale 12
Occupancy Type: Residential X Commercial Other
Permit Type: X New or Benlacement System, $100.00
Repair Existing System, $ 50.00
(Tanks or Drainfield)
0.50 State surcharge added to above fees
*See fee schedule for non-residential permit fees
Owner's Name: Ery Ka wt w. PhoneNumber:
Mailing Address: City: Zip:
Contractor's Name: Wit` Phone Number: 4/7q - 2 2Q 7
Mailing Address: Po S-,*- 3 s-q City: L cre7l's Z4r. sr-337
DO NOT MAM PAYhIENT 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),
Ed 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 NIPCA 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.
ye 1. I have received a copy of the system design including the City of Orono
T� Septic System Approval Cover Sheet.
2. I will be installing the following:
A. Tanks: X Precast Concrete
Tank Capacities: 1)EZrf , gal
_ Other Manufacturer Qrecat
2) (51c(, gal. 3) iW_ gal.
B. Pump Station (if required)
Pump make & model k1C 5^ M Y«s (attach pump eurve &
literature); system design requires yam_ gpm at 5 ,6 feet of head.
High water alarm make & model Outside
electrical work to be completed by )< installer electrician K
other Inside electrical work must be completed by
elec-.rician.
C. Treatment System:
3 Trenches: qw s.f. Mound
Depth of rock below pipe Rock bed dimensions •x '
-3 Drop Boxes Sand bed dimensions 'x '
Distribution Box Pressure Dist. Pipe Diam. "
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.
Signature ofAppl icant: i "'o 0,Q" Date:
MPCA Certification No.: 8 Sro
y-.2 8-- r 7
Staff Review: :;i
Denial
Reviewer: / Date:;g:
Reason for Denial: