Becker Township Date: Permit # : PID #: Septic Tank / Drainfield / Holding Tank Permit Application Septic Fee $: Soil Verification Fee $: LUP Refund $: Other Fee ( ) $: Total Permit Fee $: The Applicant Is: Owner Installer Site Address: City / Township Use Only PLEASE PRINT CLEARLY City: State: Zip Code: Property Owner: Name: Phone: Address: City: State: Zip Code: Installer: Company Name: Cert. #: Lic. #: Address: City: State: Zip Code: Contact Person: Phone: System Designer: Cell: Company Name: Cert. #: Lic. #: Address: City: State: Zip Code: Contact Person: Phone: Cell: Type: Residential Commercial Check One: New Replacement Type of System: I II III IV V Garbage Disposal: Yes No Dispersal /Treatment: Trench Mound At-Grade Holding Tank Bed Other: Number of Tanks: Separation from Water Well (feet): Size of Tanks: (Required distance is 50 from deep well and 100 from shallow well.) I hereby apply for a septic tank, drain field and /or holding tank permit. I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of Becker Township and with the Minnesota Health Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan. Signature of Contractor/ Responsible Party Print Name Date Approved by Building Inspector / Signature Print Name Date Page 1 of 8
BEKER TOWNSHIP CHECKLIST Septic Tanks / Drainfields / Holding Tanks This handout is a guide only and does not contain all of the requirements of the Minnesota State Building Code or Township Ordinances. Becker Township and the City of Becker work together to simplify your building project permit process. Permitting time will depend on the complexity of the work and the completeness of the document submittals. Please allow up to three weeks for review and issuance of the permit. If you have questions or concerns regarding Minnesota Pollution Control Agency (MPCA) rules, Metro West (763-684-0383) will be happy to speak with you to answer questions. The following documents are required at time of permit submittal so that all departments can complete their plan reviews and grant approval for your project: Completed and signed Septic / Drainfield / Holding Tank Permit application (page 1). Application must be signed by the existing homeowner or system installer not the system designer or home builder. Certificate of survey (recommended) or site plan (see pages 3-4) showing the existing structures, well location, names of all abutting streets, proposed tank location, proposed drainfield, proposed alternate system location, dimensions and distances to property lines and any other structures. Approved Land Use Permit (LUP) from Sherburne County. If you have wetlands on your property or are on a lot within a river shoreland or scenic river district you will be required to obtain this permit. If there are no wetlands on your property the LUP is not required. Staff can help you determine if one is required. If required, you will need to submit a Land Use Permit application (see pages 5-6) to Sherburne County. Land Use Permits are $100, which is refunded off the price of the building permit. Cash or check is the only accepted form of payment at Sherburne County. Sherburne County will forward the LUP to the City on your behalf. Two sets of proposed design. As-built survey or site plan of the installed septic system (see pages 7-8) showing the existing structures, well location, names of all abutting streets, tank location, drainfield location, dimensions and distance to property lines and any other structures. Electronic submission of all documents larger than 8 ½ x 11 to permits@ci.becker.mn.us. The subject line of the email shall include the Property address / PID # and Builder Name. Contact City of Becker with any questions (763-200-4239) Submit completed building permit applications to: City of Becker, 12060 Sherburne Ave SE, Becker MN 55308 Hours: Monday Friday, 8:00AM 4:30PM Becker Township Website: www.beckertownship.org Page 2 of 8
SITE PLAN For Septic Tanks, Drainfields and Holding Tanks This sheet is used so you, as the applicant, are aware of the requirements for the property being reviewed and to more efficiently review your application. This sheet shall be completed and submitted in conjunction with all other requirements for a building permit. If it is not, the review will be placed on hold. Please contact the City (763.200.4239) to obtain any of this information. Street Address: Acreage of Property: For Septic Tanks, Drainfields and Holding Tanks: If a survey is not available, please draw the site plan in this location. Required Setbacks* Front: Side: Rear: Closest Structure (building, deck, patio, porch) Closest Structure (building, deck, patio, porch) Well: Proposed Setbacks* Front: Side: Rear: Closest Structure (building, deck, patio, porch) Closest Structure (building, deck, patio, porch) *Proposed setbacks cannot be less than the required setbacks *Setbacks are from property lines not from street / curb edges Page 3 of 8
SAMPLE SITE PLAN (This does not need to be a computer generated drawing.) Page 4 of 8
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Property Owner : Street Address: AS-BUILT DRAWING For Septic Tanks, Drainfields and Holding Tanks This sheet shall be completed and on-site at the final inspection. If it is not, the inspection will be placed on hold. Please contact Metro West (763.200.4239) with any questions. City: State: Zip Code: Installer Name: Cert. #: Lic. #: If a survey is not available, please draw the site plan in this location. Page 7 of 8
SAMPLE AS-BUILT (This does not need to be computer generated) 30 Page 8 of 8