HomeMy WebLinkAbout1997-10-28 Septic System Permit Applicationy S 9d
CITY OF ORONO SEPTIC SYSTEM PERMIT APPLICATION
Box 66 (" , Kelley Parkway)
Crystal E -X i 55323
JOB srm ADDRESS: F' er n A 4e � 0, J
Occupancy Type: Residential Commercial Other
Permit Type: New or Replacement 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 N=e• �v,._ PhoneNumber:
Mailing Address: City: Tip:
Contractor's Name: Lluw, AV ( 17� Phone Number: 7 2-3 - 7 i Sr
Mailing Address: City: tip_
DO NOT NIAM PAYMENT NVITH THIS APPLICATION
GENERAL LNSTRUCTIONS
I. 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 nf--.nit 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. Drainfreld 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.
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.
R1. I have received a copy of the system design including the City of Orono
nn Septic System Approval Cover Sheet.
ILU 2. 1 will be installing the following:
A. Tanks: )( Precast Concrete _ Other Manufactt rer
Tank Capacities: 1) I 3 co gal. 2) f 3iv gal. 3) gal.
B. Pump Station (if required)
Pump make & model (attach pu np curve &
literature); system design requires gpm at meet 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: C(o
Trenches: - s.f. Mound
Depth of rock below pipe Rock bed dimensions 'x '
J�_ Drop Boxes Sand bed dimensions 'x '
Distribution Box Pressure Dist. Pipe Diam. "
Maniford Pipe Diam. "
D. Final Cover/Topsoil to be: _K 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:JL-,,- ,P /� 0,1, Date: /0-2F-9 ?
MPCA Certification No.:
Staff Review: Approval Denial
Reviewer: - Date: ���
Reason for Denial: