HomeMy WebLinkAbout1993-005485 - repair septic .. PEI�MIT
` CITY OF ORONO PEl�MIT TYPE:
2750 Kelley Parkway • P.O. Box 815 �-`LL��� ����� ?_�_
Per��nit Number: r�F;'� �'����'
Orono, Minnesota 55356-0815 = ��'`�'=`''
(612) 473-7357 Date Issued: _:=:!:�}:.'=�:=�
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REMARKS:
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FEE SUMMARY: ___.
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APPLICANT�PERMITEE SIG URE ISSUED BY:SIGNATURE �f�, �
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APPLICATION FOR SEPTIC SYSTEM PERMIT
CITY OF ORONO
Box 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
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General Instructions:
1 . You may a_�� for septic system permits by mail or in person at th�
City offices. However, 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
S�gtic System Ir_staller' s License.
5 . All work must be done in accordance with the approved septic system
design. Design reports are not considered approved unl.ess accompanied
by the "City of Orono Septic System Approval" cover sheet signed by
the City Inspector.
6 . The f ollowing 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 instal. lation 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 instal lation in the rock bed.
d) Final inspection to verify proper final cover depths and to
verif y that all pump station (where required) components are
functional and compl.y with codes.
7. Individual holding MPCA Installer Certificate shal 1 be present during
instai iation. 24-hour notice is required for al I inspections.
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JOB SITE ADDR.ESS: =� � �' � //�,��---, �r_`t' , -�-, ti -
Occupancy Type: Residential� Commercial Other
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Owner' s Name : ���,�i���_ _ �""7 �;���,C�� Phone:
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Mailing Address : -� - `;�' /�;� ' City: (_ /�,;%�-- � Zip:
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Septic Contractor' s Name: �,.�� ,�6�,_���;�,.�_ Bus. Phone: � ���/�✓ }
Mailing Address : �> � J � ��<< � City: ���� ,�_. tir Zip: : , -` f; s�
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;EPTIC SYSTEM PERMIT APPI�ICATON - PAGE 2
Permit Type & Fees (check one)
New Construction, Full Syste $100. 00 . . . . . . . . . . . . . .
Repair or Replace Ex ' ing stem $50 . 00 . . . . . . . . . . . . .
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0 . 50 S ate cY�c�add rmit fees
r /� SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES
DO NOT MAIL PAYMENT WITH THIS APPLICATION
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�TOTE: 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
City of Orono Septic System Approval Cover Sheet.
2 . I will be installing the following:
A. Tanks: Precast Concrete Other Manufacturer
Tank Capacities : 1) �` :;T�` 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 'x '
Drop Boxes Sand bed dime�sions ' x '
Distribution Box Pressure Dist� Pipe Diam. "
Manifold Pipe 'piam. "
D. Final Cover/Topsoil to be: bor�owed from site
('rhow Iocation on site plan)
truckked in
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'"he undersigned hereby appiies to the City of Orono for issuance of a
septic system instaliation 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 state�nents made on this application
are comp lete, true and correct. (
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Y '� ��-- l//);� �����✓ �_�- '/�`�` �7���
Signature of Applicant: �� 2 �i? -�- Date:
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:4PCA Certification No. ;}'�� �� � �
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D�A/TE TI
CITY OF ORONO � CALLED IN �' /'- �-� �D�
INSPECTION NOTICE �,j a� SCHEDULED � �
PERMIT NO. ��� � COMP�ETED 1
ADDRESS_ �-��_S �(i�':r�L��- ��G�
OWNER CONTR. �.�;��Q� � y'��-'��✓
TELEPHONE NO. �f �� - �'�S/
� DESCRIPTION ���'�-�� ,C-���
� 01 FOOTING 11 MECHANICAL RI 16 WELL TEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAVIGRADING/FILLING
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS
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Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q 05 FINAL 13 METER SET/TURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP O6 PROGRESS
J 07 UEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
i 09 PLUMBING RI 15 SEPTIC INST�� 22 FOLLOW-UP
J 10 PLUMBING FINAL 23 SEPTI F ��
� OWNER/CONTRACTOR TO MEEf YOU: ES_NO
� COMMENTS: � �O� � �
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�u/�WORK SATISFACTORY:PROCEED C PROJECT COMPLETE
� O\COFRECT WORK 8 PROCEED Cl ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. - pHOTO TAKEN
INSPECTOR WILL RETURN
C CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlContractor site•
Inspector.
White Copyllnspector's File Canary CopylSfte Notice
DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE�'/G � SCHEDULED
PERMIT NO. .5 `�05 COMPLETED `__e� �
ADDRESS o�4�� ���^a �� � ,
OWNER CONTR. ��� �;�5�����
TELEPHONE NO.
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 16 WELL TEST PUMP
Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING
� 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHORENVETLANDS
Z04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL
Q OS FINAL 13 METER SET/TURN ON 17 SITE INSPECTION
� 07 DEMO—SITE 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT
= 09 PLUMBING RI 15 LL. 22 FOLLOW-UP
J 10 PLUMBiNG FINAL EPTIC F /
Q OWNER/CONTRACTOR TO ME YOU:_YES J��o
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� COMMENTS: —` �
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d ❑WORK SATISFACTORY:PROCEED �PROJECT COMPLETE
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O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ,L, PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED
� INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance.47�73�J7
OwnerlConiractor s' e:
Inspector. --�
White Copyllnspector's File Canary Copy/Site Notice