The URL can be used to link to this page

Home My WebLink AboutPermit Building 2001-11-7 \ . 1.(. ~.. ,( ,'1t".I \ I' I~~. I Job# 01-00594-01 Page 1 of 3 (\M"~ .'1 i! TRANS# = 01.-0007193 DATE ~ NOiyl 07 2001 F~ECD ~ 2 $ 2910 ~ 9l;- CHANGE= CA8HIER~061 RESIDENTIAL PERMIT City Of Springfield Community Services Division Building Safety Job Number: 01-00594-01 225 North Fifth Street Springfield, OR 97477 Office: 726-3759 Inspection Line: 726-3769 location Of Proposed Site: 7968 S A 5t 5pr Assessors Map#: 17023630 lot: 600 Block: Addition: Tax lot #: 00600 Subdivision: Owner: Carolyn Hodges 4205 Daisy St Phone Number: 541-746-2425 City/State/Zip: Springfield, OR 97478 New Value: $42,152 Address: Scope Of Work: Manufactured Home on Private Lot MH with shop To request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following working day. Zoning: LDR FloodPlain? D Wetlands? D Journal numbers 1 : 2: Sidewalk Type: Additional ROW? D Size Of Line (in): ....'^~ \~()~~'\ \~ \\... _.~O Downspouts/Drains: ~\:\ \'0 To Drywell'-Provide Drywell En ~1:.:(\' ~?:N\\ ~ .;t\re.'. En.clnb'achr.nefiFPe.r,mit'rC) ~f'\' \yV ,,~"\ '0'" '"'~~ \ \ " ~0'\5\""r;.v . \,,,Y 'OY;~'\ San '~ewer T~e'<'i'n): 0 ',>.\$ \' \~(.\) V ,... \c, ~t.i ,\" -(~O'?.'Bopd,'E;r'Id'Q\ateTime: 00/00/000000:00 AM ~)\P ,.' '!...C'-;'\' ..-?-,<..y' ~i,S\\.(J' ....1 \/(:. \JJ\~\\' - \)\>-' , l;>.~{ \f;ypes Of Warning Devices Reqd. ~ '0 I ,,'o\f\: .;' ,. Me'S ~ . ,~.\\\'Ij '-I\! te'-'\~ :.o.on v' \ (\~ Overlay District: ' " ot\ot\ \e: .,-\~n1t;lbse.:.i ~sm~eJf-amily Dwelling ~.O'(v~ Ii 'O'l \,\ \P,c, '3.\ r:..?~Vu # of Street Trees: .c;;irr~Q 'Ao'Q\e 0~ave"Dr~,!eW3YJs~ ~,~\ ~\ S 'au. ,'\\ C\'\\ 0 (\)\ ' r\ ~ (u\e Cen\ex, () \,\\(oIJ:, S 0\ \,\\e ;r.o~e 3:\0~'?C'3.,\on ~()"\-()()"\.'" co~,e ~"'e\e\~~,c'3.'\O~ ~o\\\\ S?,.-v o'o\'a'\' o\e'. \,\' ~o\\" 'nO~~~o\} (t\'3.'1 ~\e~' ~~ n u\\x,\~ '.)A~~' . ~ g().. \\,\e ~~~. ()Xe~o ~?!~. AddltISRaM~~eq1J '{5P1e'n~s:, l49Wr>Req ulred D R . d ^tt~nl?li( , ,-".( ,s Glenwood Area? eqUlre ~_' ac 'l1Qots: Source locn: Material: Street Improvement: Curb Cut?D Improvement Agr.?D San Sewer Depth (Ft): 0 0 Storm Sewer Available? 0 Special Req.: . Security Required: Bond Begin DateTime: 00/0010000 00:00 AM Special Instructions: Other Utilities: Project Supervisor: Comments: Planner: Liz Miller Urban Growth Boundary?D Quantity Of Fill: Supplier: Drainage: Floodway FEMA: Flood Plain FEMA: X-White ~. (. ,'{j'( . Construction Types:(VN) Wood Frame ;, Occupancy Groups: Dwelling ! # Of Buildings: 1 l # Of Bedrooms: Handicap Access? D -Area (Sq. Feet) Main: 1344 Accessory:1056 Fee Residential Plan Check Total Plan Check Building Permit State Surcharge For Building Permit Building Administrative Fee Total Building Minimum Plumbing Permit Fee State Surcharge - Plumbing Water Service Footage Sanitary Sewer Footage Storm Sewer Footage Manufactured Home Connection Administrative Fee - Plumbing Total Plumbing Manufactured Home Setup Fee Manufactured Home State Issuance State Surcharge For Manufactured Homl Manufactured Home Administrative Fee Total Manufactured Home Residential - Single Family - Storm Residential Transportation SDC Administrative Fee Transportation SDC Reimbursement Total System Development Manufactured Home - Willamalane Total Willamalane SDC Grand Total Plan Check Type Checked By Initial Review-Res Bob Barnhart Steve Templin Liz Miller Engineering-Res Planning-Res I Job# 01-00594-01 I Page 2 of 3 # Of Stories: 1 Height (feet): Current Units: Proposed Units:1 Census Code: New Mfg Home Total:2400 Paid On Receipt# Plan Check 06/11/2001 5765 Value/Quantity Fee Amount 24,352 $110.83 $110.83 Building 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 24,352 $170.50 $11.94 $5.12 $187.56 Plumbing 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 115 10 50 1 $.00 $7.35 $40.00 $25.00 $25.00 $15.00 $3.15 $115.50 Manufactured Home 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 17,800 1 $105.00 $30.00 .$7.35 $3.15 $145.50 System Development 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 11/07/2001 7193 2,696 1 $365.31 $656.02 $58.78 $154.27 $1,234.38 1 Willamalane SDC 11/07/2001 7193 1 $1,000.00 $1,000.00 $2,793.77 Date Completed Comment 06/13/2001 09/27/2001 Waiting for LDAP submittal. Hillside and bringing in more than 50 cu y~rds of gravel. I: J IIi ;., I (i. ~,~} 1.. '\ Plan Check Type 'I 'I I Planning-Res \ Job# 01-00594-01 I Checked By Date Completed Page 3 of 3 Comment .I Needs to pick up LDAP Need copy of Lane County SEPTIC INSTALLATION PERMITfor our files. We presently only have a Site Inspection Permit from Lane Co. issued in 1988. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. Sam Gollah 09/10/2001 Structural-Res Don Moore 09/28/2001 I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the propery, and the apR!oved set of plans will remain on the site at all times during construction. s~~ ~ /1- 0 '7 -() I Date ., ... .,..-.~~.. -- --.....,; It\ .. Cxa 0"'1 . . -::r DO " \( ,TESTi*1 ~."1"'~ HOLe -.;;;;- ~ , r ), 0< '~ < .... I "f ll/'l--'""" , , .... , ::r- N 133 _ 01 " . i\.' I , s 3,. ~ Z 60 I .... I I' t. CHJ i~SI it 'I H 0 L..E. J..,. ^.>(]~ o rn " 'V 24' I \14' ;, 'SHoP ( v ~ '0' 4'23' t \ , ' \ . . /". ,'!. (-I 0 1"\ E 2~' I I uS.5" "1 "I '11'S ; , I ~ 'il'lsrlwsT) . \ro SHo P .. '~'T ~"."'" ... t , '\~'50UTH ft" ~ \.. SE\V AGE DISPOSAL PLOT PLAN APE-ROVED I A permit is required piior 10- starlil)D ~nsl..0'~io/" 9ATE '7/ I CO / CY BY 'f~ ENVIRONMENT d~~ '5-;;~~5 125 .. 8TH AVENUe: . E ~{fl.2f(05 I I <iJ J V P-l V 6vJ ~t ( 1'2. ' WID G) H()(V\eSI TE" :50l_7fo HOM[: 2'61-- Lf3 " S HO P : L LI ~ Ll Lf LOT: 133 'I. 32~,'7B S E P ,I C ft PPf2..CJV frl, =, "'~.4. 1'Z~-'~f4~},;::~:' - ,j;' ,.-T;",':":- ":-.;~~"': i..i,......-;;.;;".', /.A~r~(l9f.~,,,-i;~~4t-y ,l....,,;{~Ab!1!f:'; ;,:,>t';r , . .. .: ~_.~~_::.:..~~~f.";" ~'~'._'-""""\~~'tV ' ,"(h' &:.-;. .... '\t.. TAX LO"' # - . . I -, 0 '2 3" '3 0 00 fa 0 0 T1Z5 TL 17-02-3(, , Tlrv "00 ", -. ~- \Cm/\/-: 10' ./... " LV" E ..:'. <;" ,., qq " .'., .'>-+"'~",~,;??:,;;'::;?t"/;-F~"9'cX<gcc;~?!,~",to;~.'{<o/.1.:~;;_t1fi~~~~:if}k~~~{~~s::':s~;,:%,:::~;::}Ji01~}J:i~..:::...:,~~/,.,..:,'.';~:~:'~~;0~%;;7d!~~f~1&~~1?Y~.'!. . . ! , 00 (}. - 1'\ ~ .. '.j.< d (f) I 1..7 .f- ~ 50' . ~._---- t1\ " ~ {t\ _J 1 t , , (:', V . ,;) ~ V _ _ .- ~ }. <{ 'It uJ L (PROPO'Sev ) .... ::j.. ('f N r I I I , 57'S 'I ...2S ( >, , . r .?-: 'l,. , t ' _.' _ _ _ '_. _ _ _.. _ J ; _.. ",.:. I I lb' , 1. L~ " I"'\}" ......-..: ;r... ~<:'i '~'':~' I :~" ~r~;~~) ., , .I 'I . I ., I , \ , . I ,I .I \ '\ , "' 1tJ~ L\... ~ i~. } ~ ~~fO sfPr ~{,,4)./ ~~ ,. ~..J"~\~ .;' / Q ~ I I /'f- 2.-;)/ ( / .~, ~... III '~!.I" 1.11111 II I , - '. ... ,. v So, A .S7-/<.E E I .... .-...--...:;...- _----l MEMO TO: APPLICANT FROM: LANE COUNTY ENVIRONMENTAL HEALTH SUBJECT: CONDITIONS OF SITE APPROVAL lane County .-- 1. Any alteration of the natural conditions in the area approved for the on-site system or the placement of a well within 100 feet of the approved area may void this approval. 2. This approval is given on the basis that the lot or parcel described above will not be further partitioned or subdivided and that conditions on subject or adjacent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with O.R.S. 454.605 through 454.755 and Administrative Rules of the Environmental Quality Commission. Any such subdivision, partitioning or alteration may void this report. 3. This report is valid until an on-site sewage system is installed pursuant to a construction permit obtained from Lane County, or until earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department of Enviromental Quality to the owners according to Department records or the County tax records: Subject to the foregoing, this report runs with the land and will automatically benefit subsequent owners. 4. Only persons having a valid license issued by the Department of Environmental Quality under ORS 454.695 to install subsurface sewage disposal systems or an owner or contract purchaser or his regular employees may install subsurface . sewage disposal systems. A certificate of satisfactory completion will not be issued if person other than the above perform the installation. Subdivision: "t, SEWAGa;'O;ISPOSAL SITE EVALUATION /" '/ ? J 6 c::// L' ~ '""i Ct' 0 S iJ {-I-( "A 1 t V? . ~ t:., Job Loc~tion\1 I fa l> () I . ):; ....-1:.1 . 'I It ( ~ \, ,. . .. I ".... ' .'. -,,( J.). r': /Written~irec~ions ,.fZ I G Ii T o-tJ S 0'1) rn 1 9 - - '"To . 5 0 ,:.~ .r fr l, -:.. F 7 " , ^ f.. I LE f'T ft' 21-f\JD 5/ D t (1.....0 1... J U 5.1 !$E-f(J'~t:: (. 6 T tst: IN ) \J IV r II., C \/iF\lF-LtJ PED ()r..J LEfT WATER SUPPLY 4765 OfrlSY 5T. D frJ 5'1 S TRi: cT SJ. #t'?/-9/bS" . C~RS, TL /7 :tv~f~W,O~AME AND A~~~~SS eft R () L li r; . ~i:j-r:J l;fo-oG-F$ '6WNeFI'S NAME AND ADDRESS W IlL I fr'M IS. l-f(1) G{:-~ CJ w S tj,c~ST~~C~RES NOW ON THE PROPERTY to o"(\J E 5 (I fLU. (Jj<. <:;"" '1/ '-17 'l> , Phonp) 4".2 l/ L .' 5~r:,L8"7~ Phonp 7l/ t:, 21./ z ~ , .,.-J PROPOSED USE OF.PROPERTy~.qj-~'1 ~!,/J;iZ/~~r- I hereby certify that the above ,statements are true and accurate. and that I have the following legal interest in the property: owner of record; contract purchaser; ~otential buyer; realtor or agent I .f~.. rthe., rtily that (if not~h~. w.nerl I am .auth,orjwJ1, to 1.ct. lfar the owner ot record. and that said owner is aw. ar~ and approves of this action. /. . I . '~ "" ~ /. / elf: \f\Y 1 . -, (1 r if,. (., I \ i , ., (, 0 I TEST HOLES READY ,.. ~;/L/,. ,//L//--:/ .1l 1 '/ .j', SignatureL.6..JLh~ .'T0"t.Y5..e-d. Oat/> 10, i.. ! * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * OFFICE USE ONLY BELOW THIS LINE * * * *(.,)* * * * * * * * * * * * * * * * * * * * * * * * THIS REPORT IS NOT A PERMIT FOR SEWAGE SYSTEM INSTAllATION \::'~ ;;':''''''''' 7/1 r;;j(/(' is . ,A~.t/7}?'oO(P "/T ,--. for a The area describe~....p~Athe, ~~E\ched plo~a,n ,g;8ted ].,---rfVv }--I L/y c'f{ ADDITIONAL COMMENTS: tV/ /t:;()/ ( (iF system: " :' Pi2~-1 fl.) R{:~ . NOTE: If this report approves use of a sand filter or pressurized distribution system, detailed construction design plans will be required .with the installation permit application. .' / . 7 II f; fey' /E() AUTHORIZED AGENT I DATE I LANE COUNTY LAND MANAGEMENT, 125 EAST 8TH AVENUE,.EUGENE, OREGON 97401 (682-3823) C55-32 THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF AlFUTURE BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE' UPON THIS" R.FPORT ARE AT YOUR OWN RISK. IF SITE IS APP~OV~D, SEE REVERSE SIDE. /d-ff- ... * *.'*.'.i'. '* * * * * * * * * * * * * * * * * * * * '* * * * * * ."* * * * * * * * * * WARNING: * * * * This .SiteE~,~Juation is a technical report to determine if a on-site * * system will function properly. It does not approve the proposed use of * * the parcel. Thi!;h,Site Evaluation may be converted to a construction * * permit only if the parcel and use meet land use regulationsin effect at * * * * the time of application. YOU ARE URGED TO CONTACT YOUR LOCAL * * PLANNING OFFICE FOR LAND USE REVIEW. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 225 FIFTH STREET SPRINGFIELD, OR 97477 (541) 726-3753 FAX (541) 726-3689 MANUFACTURED HOME LAND USE AGREEMENT As required by the City of Springfield Development Code, 1 agree that with the approval of the attached permits, one of the following manufactured homes will be placed at 7't;. 9, 5 - i4. I s....r..-, Springfield, Oregon, City Job Number t!J! -I)O~. ,,-- Type 1 Manufactured Home. A multi-sectional (double wide or wider) unit with an enclosed floor area of not less than 1,000 square feet, that has a nominal roof pitch of3 feet in height for each 12 feet in width, that has no bare metal siding or roofing, and that has been certified by the manufacturer to have an exterior thermal envelope meeting perfonnance standards which reduce heat loss to levels equivalent to the performance standards required of single family dwellings constructed under the State Specialty Codes. Type II Manufactured Home. A unit of not less than 12 feet in width with an enclosed floor area . of not less than 500 square feet, that has a nominal roof pitch of2 feet in height for each 12 feet in width ,and that has no bare metal siding or roofmg. The manufactured home shall be placed on an excavated and back-filled foundation not to exceed 6 percent slope within 10 feet ofthe perimeter enclosure. The perimeter foundation wall surrounding the home shall be constructed of stone, brick or other masonry materials, and with no more than 24 inches of the enclosing material exposed above grade. 1 further agree to meet all land use and City Code requirements of the above mentioned parcel within 60 days of the date of issuance of the manufactured home set up pennit. These.requirements may include, but are not limited to the items listed below. Specific land use requirements regarding your parcel are noted on your approved set up plans and/or pennit and your partition approval if applicable: . Street Trees o Paving Driveway . Minimum 32 square foot storage structure . Completion of partition approval . Removal of any existing structures as noted on your partition approval . Signing and recording of any required partition, easement, improvement agreements, etc. . Final lot grading . City Sidewalk and curbcut installation o Any outside agency approval as required i.e., Division of State Land approval. By my signature below, 1 agree to complete the above mentioned land use requirements. '/ ~~ II-D'7'DI Owner Signatur~~ - Date Contractor Signature Date DRAINAGl XTURE UNIT (DFU) CALCULATlvN T~BLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS, CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO. OF FIXTURES DRAINAGE # OLD ) UNIT FIXTURE x EQUIVALENT = UNITS ) x 3 0 ) x 1 0 ) x 3 0 ) x 3 0 ) x 6 0 ) x 2 0 ) x 3 0 ) x 6 0 ) x 12 0 ) x 1 0 ) x 3 0 ) x 2 0 ) x 2 0 ) x 3 0 ) x 2 0 ) x 1 0 ) x 2 0 ) x 1 0 ) x 5 0 ) x 6 0 ) x 3 0 FIXTURE TYPE BATHTUB DRINKING FOUNTAIN FLOOR DRAIN INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. INTERCEPTORS FOR SAND / AUTO WASH / ETC. LAUNDRY TUB CLOTHESW ASHER / MOP SINK CLOTHESW ASHER - 3 OR MORE (EA) MOBILE HOME PARK TRAP (1 PER TRAILER) RECEPTOR FORREFRIG / WATER STATION / ETC. RECEPTOR FOR COM. SINK / DISHWASHER / ETC. SHOWER, SINGLE STALL SHOWER, GANG (NUMBER OF HEADS) SINK: COMMERCIAL/RESIDENTIAL KITCHEN SINK: COMMERCIAL BAR SINK: DOMESTIC BAR WASH BASIN LAVATORY URI:NAL,STALL/WALL TOILET, PUBLIC INSTALLATION TOILET, PRIVATE INSTALLATION MISCELLANEOUS DFU TYPE NUMBER OF EDU's* ( # NEW - ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 ( 0 o o o o o o o o o o o o o o o o o o o o o (0 0) x 20 0 TOTAL DRAINAGE FIXTURE UNITS =, 0 'EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE IF IMPROVEMENTS OCCURRED AFTER ANNEXATION DATE, CALCULATE CREDIT SEPARATELY YEAR CREDIT RATE PER $1,000 YEAR CREDIT RATE PER $1,000 ANNEXED ASSESSED VALUE ANNEXED ASSESSED VALUE 1979 OR BEFORE $4,74 1990 $1.96 1980 $4.65 1991 $1.55 1981 $4.59 1992 $1.36 1982 $4.46 1993 $ 1.23 1983 $4.30 1994 $ 1.05 1984 $4.14 1995 $0.90 1985 $3.93 1996 $0.75 1986 $3.63 1997 $0.57 1987 $3.26 1998 $0.35 1988 $2,85 1999 $0.15 1989 $2.40 CREDIT FOR LAND (IF APPLICABLE) CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1000 CREDIT RATE 0.000 x $0.00 =1 0.000 x $0.00 =1 TOTAL MWMC CREDIT =1 $0.00 $0.00 $0.00 l I I =1 $0.00 I =1 $0.00 I =1 $0.00 I 1055 =1 $0.00 1 1056 =1 $0.00 II =1 $1,175.60 I ,'*"1.. . CITY OF SPRINGFIELD 'sYSTEMS DEVELOPMENT CHAR "WORKSHEET JOURNAL OR JOB NUMBER: 01-00594-01 NAME OR COMPANY: HODGES LOCATION: 7968 SOUTH 'A' STREET TAX LOT NUMBER: 17-02-36-30-00600 DEVELOPMENT TYPE: ,SINGLE FAMILY RESIDENCE NEW DWELLING UNITS: 1,' BUILDING SIZE: 2400 SF LOT SIZE: 0 SF J - STORM..DB.bINAGE DIRECT RUNOFF TO CITY STORM SYSTEM' IMPERVIOUS S.F. ') 'COST PER S.F. I O~OO , I $0.271 =1 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS IMPERVIOUS S.F. x COST PER S.F. I x DISCOUNT RATE 2696.00 $0.271. 50% I ITEM 1 TOTAL - STORM DRAINAGE SDC . LSANTTARY SEWER - CITY A. REIMBURSEMENT COST: ' NUMBER OF DFU'sCOST PER DFU x o $21.25 B. IMPROVEMENT COST: - I NUMBER OF DFU's' . . COST PER DFU , x I 0 $16.15 I ITEM 2 TOTAL - CITY SANITARY SEWER SDC 3....IR,A NSPORIA.TTON A: REIMBURSEMENT COST: ADT TRIP RATE ., x NUMBER OF UNITS.. COST PER TRIP x NEW TRIP FACTOR 9.57 1,. ,$16.121.00=1 B. IMPROVEMENT COST: ADT TRIP RATE NUMBER OF UNITS x 9.57 1 $0.00 =1 -$365.31 =1 $365.31 =1 $0.00 =1 =1 $0.00 $0.00 $154.27 x COST PER TRIP $68.55 x NEW TRIP F ACTORl ,'1.00 =1 $656.02 ITEM 3 TOTAL - TRANSPORTATION SDC ~. SANITaRY SEWER - MWMC A. REIMBURSEMENT COST: NUMBER OF FEU's COST PER FEU x o $285.91 B. IMPROVEMENT COST: NUMBER OF FEU's COST PER FEU x o $24.33 .MWMC CREDIT IF APPLICABLE (SEE REVERSE) SUBTOTAL OF MWMC REIMBURSEMENT, IMPROVEMENT & CREDIT MWMC ADMINISTRATIVE FEE =1 $810.29 =1 $0.00 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBTOTAL (ADD ITEMS 1,2,3, & 4) .LAl2MTNlSTRA TIVE FEE' SUBTOTAL ADM. FEE RATE x $1,175.60 5% =1 $58.78 ~T~' . 6/20/01 TOT AL SDC CHARGES = $1,234.38 SDC COORDINATOR DATE .- ....-...-..,.. -... ..,,--- ~ r./J ~ Q o u ~. ~ ~ r./J ~ d .~ ./ 1070;, . 1091 1092 1093.-/ 1094... / 1073 ,t . 'i1 { '. '.' .-''''Exhibit "A"** r IMPROVEMENT AGREEMENT INCLUDING NOTICE OF POTENTIAL ASSESSMENT LIEN . (In Lieu of Immediate Construction of Public Improvement; includes Waiver of Right to Remonstrate) IN CONSIDERATION of the covenants herein recited, the City of Springfield, hereinafter referred to as City, and Darrvl S. Doaali and Dorothv C. Doaali, hereinafter referred to as Applicant(s), do covenant and agree with respect to the real property described beloW as follows: 1, Applicant(s) warrants and represents to the City of Springfield that it is the owner of the property more particularly described and set forth in Paragraph 7 below and, as owner, has the authority to enter into this Improvement Agreement with the City of Springfield. 2. Applicant(s) desires Development Approvalfrom the City with respect to the following Development Application -$UI L..'D INEr ~(4tM IT 0 \ - 005'\':\-0'. 3. The development will cause both an immediate and long-term demand on the various public facilities of City and Lane County including the specific public improvements necessitated by the development as set forth in paragraph 6. 4. This Improvement Agreement is an alternative to imposing a condition on Applicant's . development approval that the Applicant make immediate construction of any public improvement that the development necessitates. The objective is to promote efficiency, coordination, and spread costs by providing an opportunity for a district wide improvement mechanism where construction occurs in a coordinated project with the participation of adjacent and other properties in the area, instead of requiring immediate improvement in conjunction with each development application. There is no guarantee, however, that such a coordinated project will be possible and the City reserves the right to require construction of the improvements in the future at City discretion. 5. (a) Applicant and City agree that Applicant will pay the cost of the following public facility . improvements described in Paragraph 6 in accordance with respective cost assumption policy established by City at the time the City determines to undertake and complete such public improvements. (b) Applicant and city acknowledge and agree that the cost of such improvements and the portion thereof to be paid by Applicant are presently unknown and may be greater that the costs that would be apportioned if the improvements were constructed immediately or by Applicant now or later. (c) Applicant acknowledges that the timing ofthe construction of such improvements is within _ the sole and exclusive direction of the City. 6. (a) STREET IMPROVEMENTS along the frontage of Mains Street and South "An Street. to include: (X) surface paving; (X) storm sewers; (X) sanitary sewers; (X) curbs; (X) gutters; ( X) planter strips;. (X.) street trees; (X) street lights; (X) sidewalks. (b) TRAFFIC SIGNALS at the intersection of (c) OTHER IMPR'OVEMENTS . f. \ Applicant acknowledges thatthe list of marked improvements reflect those that would currently be required under the appropriate City codes and ordinances. Applicant acknowledges that it understands that the improvements made will be those required to bring the street to full urban standards for the then current functional classification of the street as those standards exist at the time the improvements are made and may, therefore, differ from the list of improvements checked herein. i- (Bar Code Slicker) RETURN TO: CITY OF SPRINGFIELD - PUBLIC WORKS DEPT. - 225 PIFnI STREET.. SPRINGFIELD, OREGON. 97477 .. { E;"'-::' --....-. ----- .---" ..---- - -- -------~.. ~t: ~ E C.::>PI€:S, o {2..(~ ( ,J ~ '- .S r?{~~ up "a,-\ ,-,,,"''r,,,~0 \ , .-/ I I c:> ,....;)e..~ "\ \ T L--- c:-O/'-^,?A,V"1 I , I I i o ~ "7 }hillS ::Jv;cl ~ t- \ z....::> e::> I ~ ll~lJro ~/~/U~r) j C€i SfrE:I/';: F...... ~~ (!e;>P(~~. i/lib ~60 "n'a&" t1V 9 /26/tJ1 ~ 7)0 N07 :r>S0~ ~"'" ,r- UAl'l! G snvC Rc-tCASEO 6bz..t<\ 't. " 7. LEGAL DESCRIPTION: . (SEE EXHIBIT "A") AKA , .' 7'l <C'B S... A ST ~e: Er Property Address 17 -02 -36-30-00600 .Tax Lot No. 8. City agrees that Applicant's execution and performance of the terms of the Agreement will be deemed to be in compliance with City's policy pertaining to improvement requirements, and if Applicant complies in every respect with all other applicable laws of the State of Oregon, Lane County, and City, Applicant shall be entitled to Development Approval, subject to the terms and conditions of approval set forth therein. . 9. This agreement is enforceable by the State of Oregon, Lane County or City. 10. APPLICANT AGREES TO SIGN ANY AND ALL WAIVERS, PETITIONS, CONSENTS AND ALL OTHER DOCUMENTS NECESSARY TO OBTAIN THE ABOVE LISTED IMPROVEMENTS UNDER ANY IMPROVEMENT ACT OR PROCEEDING OF.THE STATE OF OREGON, LANE COUNTY, OR CITY AND TO WAIVE ALL RIGHT TO REMONSTRATE AGAINST SUCH IMPROVEMENTS. Applicant does not waive any right to prolestthe amount or manner of spreading the assessmentlhereof, if the same shall appear to lhe App/icanllo bear inequitably or unfair upon said property of Applicant. Applicant's acceptance of Ihe non-remonstrance condition is in consideration lor the City's waiver of the requirement for the immediate construction of the public improvements thatlhe development necessitates. This improvement agreement waives the property owner's right to file a wrillen remonstration. II does not waive a property owner's rightto comment on the proposed district or any related mailers orally or in writing. 11. II is the intention of the parties hereto that the covenants herein contained shall run with Ihe land herein described, and shall be binding upon the heirs, executors, assigns, administrators, and successors of the parties hereto, and shall be construed to be a benefit and a burden upon the property herein described. This Agreement shall be recorded in the Lane County Deed Records. . NOTICE TO APPLICANT/PROSPECTIVE PURCHASER If you are the applicant or a prospective purchaser of this property, you are advised to discuss this Agreement with an Attorney of your choice. Execution and recordation of this Agreement will place requIrements on ,the Owner and any subsequent purchaser of the Real Property described in Section 7 and their heirs, successors and assigns. These requirements include but are not limited to the payment for the public improvements described in Section 6. This may result in an assessment lien on the Real Property described in Section 7 and significant costs to the Owner and Purchasers, and their heirs, successors and assigns. An Applicant's signature on this Agreement indicates that the Applicant has thoroughly read th}s Agreement, understands it, has had the opportunity to consult legal counsel prior to its execution, and understands that execution of the. Agreement may result in significant financial obligations imposed upon the Owner of the Real Property. Any prospective Purchaser of the property burdened by this Improvement Agreement should also thoroughly review this Agreement, consult with legal counsel prior to purchasing the property, and understand that this Agreement may result in a significant financial obligation imposed upon any Owner of the Real Property described. in Section 7. ' WHEREFORE, the parties have set their hand this day of j- J b.c 0 ( , 2001. .By . Do..ru4 ~. \)~~ Darryl S. D09ali V By STATE OF OREGON ) ) ss. COUNTY OF LANE , ,) . .:..-:-- , On this / ~' day of 0 ~fw , 2001, there personally appeared before me the above named applicant(s) DCU+vl S. Doaali and Dorot . I) OFFICIAL SEAL .' CINDY S NICOlAYSEN .. . NOTARY PUBLIC. OREGON '", .,,/ . COMMISSION NO, 318191 ; . Plf COMMISSION EXPIRES DECEMBER 25, 2002 Notary Public or Oregon My COfTlmission Expires RETURN TO: CITY OF SPRiNGFIELD - PUBLIC WORKS DEPT,- 225 nITU STREET - SPRINGFIELD. OREGON. 97477 . .... ,.:\to_ ~ .''Do,. rz... ~ By Don R. Rogers _ City strveyor STATE OF OREGON ) ) ss. ) COUNTY OF LANE On this 2.t::12L- day of ~Tc.J c-'1', 2001, there personally appeared before me Don R. Roge'8, Ihe City Su",eyor, toe .Ihe City "fSprlngHeld and signed "!J::~e d9P' ~ Notary Public for Oregon My Commission Expires 04 - 2. 0 - 04: I> OFFiCIAl SEAl. DENNIS P ERNST ,: IOTARY PUBLIC .OREGON . \" .,/ COMMISSION NO. 333871 .COMMISSION EXPIRES APRIl 20, 2004 - . EXHIBIT "A" That tract of land, described in a deed from Donald Joe Duncan and Mary Ann Duncan to Darryl S, Dogal; and Dorothy C. Dogali, recorded for public record February 16, 1999, on Ree12516Rc;lt Reception No. 99-014091, Lane County Official Records, Lane County, Oregon, being more completely described as follows: Beginning at a point that is 202.90 feet North 00 13' West and 1362.35 feet North 780 22' East of the Southwest corner of the Nelson Davis Donation Land Claim No. 50, Township 17 South, Range 2 West of the Willamette Meridian, Lane County, Oregon; running thence North 110 38" West 326.98 feet to the Southerly right of way of the McKenzie Highway; thence North 780 22' East along said right of way line 133.22 feet; thence South 11038' East 326,98 feet; thence South 780 22' West 133.22 feet to the place of beginning, in Lane County, Oregon. ' . . RETURNTO: CITY OF SPRINGFIELD - PUBLIC WORKS DEPT. - 225 FIFTH STREET - SPRINGFIELD, OREGON. 97477 " APPLICAN1"S cort SEPTIC INSTALLATION PERMIT ,SP017355 . f.~n~ _"0'0"' ounty .~ . ~t~'11Y0 7~ ~~i~~)11 s..5'-;~ . Public. \\brks . Parcels: 17-02-36-30-00600 1~6~5, A . Site: MAIN ST TO S 79TH L ON SO A . Applicant: . HODGES CAROLYN A 4205 DAISYST SPRINGFIELD OR 97478 . Owner: DOGALI DARRYL S & DOROTHY C 1020 6TH ST SPRINGFIELD OR 97477 Site Inspection Number: 01-9165 Work Description: SEPTIC INSTALLATION System Type: INSTALL, SAND Applied Date: 09/26/2001 Approved Date: 10/16/2001 Issued Date: 10/16/2001 . Expiration Date: 10/16/2002 INSTALLATION REQUIREMENTS: Projected Daily Flow: . 450 gallons Septic Tank Size: 1500 gallons Drainfield Size: 150 feet Maximum Depth of Drainfield:24 in. Special Conditions: INSTALL DRAINLINES ON CONTOUR IN AREA AS SHOWN ON APPROVED PLOT PLAN CALL FOR INSPECTIONS OTHER REQUIREMENTS: I, Ne\V system must meet setback requirements in Table 1. 2, Installation of a.t:l effluent pump requires an Electrical Permit that is not part of the Sanitation Permit. Plan to apply for the required State Electrical Permit at the LMD office. 3, This permit will expire after one year unless the system has been inspected. To obtain an inspection, make a drawing of the system as installed on .the form provided. Submit the complete form to this office and the inspection will be sChed~e;d. i1pection for sewage systems! ::::::!requeSled by telephone. '.Au~OEQ ~gent' Date LANE COUNTY ON-SITE-SEWAGEOFFICE 125 E 8TH Avenue, Eugene OR 97401. PH: (541) 682-3754. Fax: (541) 682-3947 . .~~~ ~~ Public Works LAND MANAGEMENT DIVISION TO: SEWAGE DISPOSAL SYSTEMS PERMIT APPLICANTS FROM: LANE COUNTY ON-SITE SEWAGE SECTION You are required by law (OAR 340-71-160) to be in possession of a-permit authorizing installation of a sewage disposal system before construction can begin. In addition, the law specifies that all work on said system must be performed by a person licensed with the State of Oregon Department of Environmental Quality (DEQ). The work can also be completed by the owner, contract purchaser or their regular employees. Before starting any digging, carefully read all the specifications on the installation permit, plot plan and plans. If you have any questions regarding installation procedures or specifications of the approved area, call your area sanitarian at 682-3754 and they will be glad to assist you. If you intend to hire someone to do the work for you, you should make sure that the person is licensed with the DEQ to perform such work. This protects you as the consumer, as each licensed installer has to post a bond and is liable for the work performed. To check the licensing of an individual, you can call the Lane County On- Site Sewage Section at 682-3754 and we will check for you to see if the individual or contractor you have chosen is licensed. ORS 454.705 (3) requires that every licensed installer must provide to each permittee (oW11.er) a written notice of the name and address of the bonding agent and of the permittee's rights. This must be provided before the work is completed. We urlle you to request this from the installer or contractor you have chosen orior to hiring them. When the construction of your septic system is complete and before you backfill, it is necessary to have the system inspected. To obtain an inspection, make a drawing of the system as installed on the detailed system plot plan (As-Built) form provided. Submit the completed As-Built form and Materials List form to this office and the inspection will be scheduled. Final insDection for the sewa!!e system cannot be reauested bv teleuhone. Do not hesitate to contact Lane County On-Site Sewage Section if you have any questions. 125 E. 8th Avenue 97401 LANE COUNTY ON-SITE SEWAGE SECTION / Public Service Building / Eugene, Oregon (541) 682-3754 I:\myfiles\cvr .ltr. Word LAND MANAGEMENT,DIVISION / PUBLIC WORKS DEPARTMENT / 125 EAST 8TH AVENUE / EUGENE, OREGON 97401 / FAX 541/682-3947 BUILDING (541) 682-3823/ PLANNING (541) 682-3807/ SURVEYORS (541) 682-4195/ COMPLIANCE (541) 682-3807/ ON-SITE SEWAGE (541) 682-3754 .- =- ..'? '._"-'~.--... --...--........,,; , ()Q ;;!~ ~ .. '" d (f) 133 1'\ ... ()Q 0""1 -:::r ()Q ". ~ I TE'S r 1*1 ~l"'~ Ht~ I '~ ( .... , -;r 8/.)S':--.~ , r .... J ~ M f\ " I I I I 57's ( .1 V ~ ,.,.281 ;>1 (,\ - I" f ?;l.- ' -l- _J-.. '- - -- - ~ I , s 3. ~ 51 60' '- . o f() , S~ NO FILt'~ iK~ to' - ^. i. , 17.f-7 50' v 4<6' l" .... ;;' - '.! . (-I 0 IV\ E lZ' ....----....- 1\ 1 , , 1 It:" V I . ;)'~ V _ _ ._ , ,. " '~w L ~ (PRO paS'CD ) , :)0- N N r J -.. ..:. , , i. , , l~' ,} ,I I I I I \, , I .1 \ '\ , ,1 , ltJ~ Ll.. ::\ i \, } All ,15 fft6-f>oscPJ~~~.q.;/ t:v~~., .~ ). / ~.J"R--~ '" . / Q 1'1 r /,r-- '1..~/ / / ./ ..".. ,.\1"... ",.... .,. .. '. ." "...., A." I I/LCf1J TiE'ST 1t., HOtS I- i\ )[J :z I I ~S5 >,1 v V 24' , yy, ) 'SHoP < 11.$ :; :1 , I ~ <3 'IS. s T(~EEr) . " \ro Sl.to P VI .--.....~ -_ ..---...1.. _ So, 1\ .57- f<E E I . A" \.. SEvY AGE DISPOSAL PLOT PLAN AP~'ROVED " A permit is required ~ATtiOr I~ ~7/&;7or' BY 'f~ ENVIRONMENT dE~ 's~R~C~S 125 .. 8TH AVENUE , E~(JI5f;05 1113 ' V P-l \J f"W {\41 ( 1'2. I WID G) HOMe51 TE" :50"l.{~ HoM~ : l~ 1-- Lf3 , S 1-\ 0 P : L LI ~ L( Lf LOT: 133 x. 32(','73 S E P II C. /1 P P (<.. Oil frl. ' ,:, .....~~...Lt.1!--' .-... --,:.~', ~..i; -..r_:?' ".- ':" n ,.,~.- ','~' . " ..:.-...... --:"', /:<'>4 .".":,. ).(J:"')~."(.~ ;i"I'!f.':.';;~.~':';".' . .:'~.~~_!:.~~_ __ ~_ -, ~{,~.:., ,1~~V".':.~'; ~ .;;" .... . TAX' LO"T # " . 170 L 3" "3000 fa 00 Tt<S TL 17,-02-3(, , TLtv foOD so ~, .~- \CffiA/- /0' ;/ LU+ r= /. /. C:::' ,., qq ,1 m__.---.J SEWAGE'D;ISPOSAL SITE EVALUATION '6:rRS,.~TL'~/ 7 tPc"..$ 2'. 6 ~/ Job Loc~tion 1 '110 '3 5 aU 71-1 I' f\ J I 'II '. "( d' o I G ti T (}rJ S DU 7, ;J 7 9 ~ - l' l') c.> ti l'J'7-h,' ",At' l [ F.- -7, . , .Written Directions '" r / . - , , , 0.., Cfr::,-\ f-11ry[\JO .s/nf.',. (lOT JU5T [;.EfCRf: LGT 15!;troJ., N I ....' "hE il f Lf) f' F D ()t-J C E f .,- ,/ I' ':-?b /-- ;f'!"') - ./' ~ l S.I. #C/ / / / '7-J Subdivision: '0WNeA'S NAME AND ADDRESS /l;:'l? (.. Cz;..,.,f, STRUCTURES NOW ON THE PROPERTY CU;~f~~~:r.:~O~AME AND A~~=:SS eit R D LV r; A rJ'f\J /;1o-V6e-S VJ ILLI frfvl R. HUOG-f-<;' l.J"Z.D S t-Jo f-J E WATER SUPPLY 47..05 Ofr.i S If 5 T, D frlS '1 S n<.l: e1 $ P fL U. ().J<.. IJ .;-- '1, i/7 "6 Phonp ") I.{ " - 21 "Z '=> SrfLl) ()f< q"7 4 -; <j.., Phonp 7lf ~ ~l, "/ 7.. S:.;:- --; PROPOSED USE OF PROPERTYr ~~r''';;r7J7:/-;t...~:,r I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: ....wner of record; ~ontract purchaser; ootential buy€" , realtor or agent. I furth~...certify that (if not th.~;;9wner) I am. ,aut~0~1d to l?t for the owner of record, and t~at said owner i~ awar~! a.nd approves of this action. . I I ( .d~~ ,'_....'/ 'or If}'. -', { .1 C cf I-I \ i ( .) G ; 0 J TEST HOLES READY / E... ~j2 ': ",//://..../ V t: '1 'J .j, Signature A.Jt..n-{t..1~Ir- . TVl:..YC}Jl..-.</- Datp b i C ! " "-. 1!-1 .. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * OFFICE USE ONLY BELOW THIS LINE * * * *(..1* * * * * * * * ** * * * * * * * * * * * * * * THIS REPORT IS NOT A PERMIT FOR SEWAGE SYSTEM INSTALLATION The area describe~-::.o~the, ~WCi\ched plo!_plqn -Pc;ated ..I/f-rVV f-( V( r::--f( . "/ ADDITIONAL COMMENTS: !/'o/,/ I s"1T) I ( ./ ~. :--.... / / (i" / Ii/ ,/; . 1. I Vt is ~>4.'rl'}?o u (V for a (IF- , ,system. . [;"'l/Z1.y /1) Ire ( cZ.t::::;; NOTE: If this report approves use of a sand filter or pressurized distribution system, detailed construction design plans will be required with the installation permit application. THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A./FUTURE BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS"" REPORT ARE AT YOUR OWN RISK. IF SITE IS APP'0V~D, SEE REVERSE SIDE. /1' ./' , . ,/1 -1: ~. . f '-. .,,/ ".-.., . / ....~~~..-. . . p. .- "".. ,--. I. IGi. , "";,,,. t' )- .' " / ~ V ../ '/'L>\ (/' / / / L~;,i ..",~[)ECi AUTHORIZED AGENT t DATE ! / LANE COUNTY LAND MANAGEMENl:, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (682-3823) C55-32 * **~ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * WARNING: * * * * This Site Evaluation is a technical report to determine if a on-site * * system will function properly. It does not approve the proposed use of * * . the parcel. This.Site Evaluation may be converted to a construction * * permit only if the parcel and use meet land use regulationsin effect at * * * * the time of application. YOU ARE URGED TO CONTACT YOUR LOCAL * * PLANNING OFFICE FOR LAND USE REVIEW. * * . * ". * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * . . r~~ It...- ~_ , "" , ,___,._.._._..___y _... _'.'.. , <<0 t, ~ 40 ,......_,- - - o ---!~. ,', . . ." '-5 I d"--'')..7,S-- (f). 50' t; ~~ '^ ~ ............"... , 00 ().. .. I b <3 'ISr(~tEr) . I lro .SHo P 133 - . .... .., J\ j' I 1/4. 'n> t s' 'Slf,~'iJ' I 1.\\~[7- )i-~ I \"vt v I ~ ~ ___ '\E',1' ~o / "- ~?j? ~O -;fl / 2Yv, , ~ 1.,5__. [: Sft NO ~ '1 yj lli!;:r€.e:J ;. '5 HoP ( 1\ . -------- t\ t I I / 57JS , >, r . r .');}.. , i ' --_.. I_I ,f 7 b ' - - - T - :1 {-I 0 1"'\ E 2~' '" ~ "It2J ( , I (,\ -. , , , 1 V '-- _ ._ ._, ...:. 'If -( I I . I ~ 1 : gl~~;i:; ?i,;.',~:t. I ~!f~r~%~~ ) I' ,/ 'I . I / I I \ \ , I I ; ,I \ '\ I \ J ~ .~~~q)j ~~ . ,/ (::'\ ,J' ~\~ // Q //t--/2f~/ / / ./ -- '-. .. \1 ----..... I.' ---....... \I , . So,A~ sr~EE-l . '.'":-;i!50UTf-t ft" ...., - ~ .'. ..." ,,: '. \.: ".~.:i.'\r _', .~;i"Li"'!'t ;...~, ~hf n~~~-.:..! \;~;hl.O! ;;~n~~r.A'~!:i~1 ,t..... l.~~l.i~ r~~\r~. ,l(~ t~~ !!.:..tti ~=' :L~n ~51~'.,U~.r:~1{! ..,~_tt~l ~:'\~ ~I~).t~; i 'fl~1:U. ~In~ "~,,. H~rll'B t~ie~ t,~ ..;'. ,..\.:#';: If-';' t~;i~~.' .:.t'\t ':.:t;t(r~'i. ;rlfo:~t.: If'l4J U~It?hn:lfl :...'....: ~'ti~ ~Cv.. .~~.~'~..I~n ~)t\~~":'\: ~;.~J;~:~z.~;~:-r, :"'.~~~.~~' :r .': :t:., ", \, 1.7'S' ) I I ~ I tJ 8.1 U ~ W r0-f (1'2.' wIDe;) : ) , , H 0 (V\ r:: 5 1 T E" .' 50 i. 7 ~ I ' HOME: Z<i) 1-. Lf3 . 'I I 5 HoP : L L/ X Ll Lf LOT: 133;( 32(,,73 S t P II C f\ P P {2. Oil Ai... . . .~. 'ii~:~iL"I..";;j' ._';;;.; ..,...:. '4. :..~.', 1'''''~. I" \"(. .. "'.' ':<'~',:k: :"-if',\.o{ ,'; it/. h. ""l'n>' , .,..._'. -:._.....-:'!4.f Lf ~t' \......''J ..... &:.- TAX LOT i=t / 7 0 L 3~, '3 000 to 00 . T(( S T L I 7 ,- 07. -. 3 (, , Tlr\J foOO I C/lI?OLyN-hG Dc;E5 I ~20S- ~;~ S;;n ISpe;1V'511CU:? az.. 9 ?f/7r- ! [5.v/) - 7s/6 - 2 ~.?j- ... ._","._-.J,.._ "IIiiiiiii1:1';,I.~~~'. \ C In::' 10 I N , S P 0 1.- ---r~s:J -------- !r,!/,('..I..,";oll\tl<i" ""'..[HI'};, OR 974711 SOl /.71-01 t/, A -----~'g\\.-llT.._.c.::.;.-=:'....-7;.:''':..-......-.................."'-;::.;w1-\'23.\\- --- " ~ > ~ , ~ > ~ > ~ > ~ > ~ > .. ELECTI\JC CONDUIT TO ~ ~ POWEI{ SOUf{CE. > ~ L:::.:.::.:./ ~.~.~.~ \. [:+J ~"""'+'+'+'+"'+"""""""'.""'."'.'. .. :: ,:.;,~;,..~ ;,.<;;, f r:t~~,~.;,~:::~;,.~;,,~;,~,~~{ ;,,= ;,.~ ;,,~:;,~;..:;,i.: ;',: i~i,~;,,~;,,:;,~ ;,t.~;,,~;,,~;,i~ 2" SIJWE C/(CiIJNIJ AWl'. Y !'l(l)M RI';!:R -------- \\3.\\ o , !'JIlEI:, ;1.1'.:;', 1.11) WITH :;Ji'.I/-JI.I:~~ STi;l,1. 1l()/.'fS AND I;JWllfMJL (;A~,t:I:T .-/ ,C;'IYN()/'IMM INSlltA FIIIN (/)VI,) / ~.,..""""",-",,.,.,...",,:::: "'~\\ / 1J \ _______ 2-1" UI/\. HIIIllUJ I've I<I~U\ ~ ~- wI NEO/'J(Fr-JF GI{OMMElS ~ - . ~ ~-"' _ 1" OIl>. J've HOgE AND VAI.VE ASSEMIlI,)' ~ OPTJONAL: now CONT/WLLfII. A'f.@ ~ ~ ~ IJI IX WI CORD GRIPS i : i:,..n1-~;~'- --- r~]-l I ~l~ I "';:'.""- , .. I ;"-;-- 1 .(,..::. , ..<' I .~t; ,::!,:, ), t -- 2" ~ LIQUID LEVEL V ---5:5"-~- .."."." -.. ~ .-.-.---- . -: -. 3,5" ALARM '."~'~'" -- E'TLlJENT " ., -~ DISCHARGE :':...~.1 -1" DIA FI EXIULEPVC HOSE ( J2' r ':.~,. ~""~~~:}::1___________ LONG WITH FIITINCS) I t.i: ---..----........ 2-I'A/n EPOXY (/,O/lrnrrlll/l'/ :-::. fibas'aS5 ns('/" anrJptnJ -l~-<- t f f :. .~~.<< I'OLYETHYl.ENESCI(EEN l,. , I ?' , 4" DIA rove FLOWINDucm .~':----- ---'.: I .;f.~ IlRONZECHECKVAI.VE -----$: r___ (8) J.3/8" DIA JNLl:"T HOLES ,f. ~ AROUND PERIMETER OF ~ : VAULT -1,.. Dill I've VAULT Qt' OFF Ji:r . NOTE WITIi THE FLOATS ARJ(ANGED AS SHOWN. EFfLUENT DRAWDOWN WILL CX:CUR IN THE SEPTIC TANK, .:: }..': y ~~.~.~ -- +~~~~ ------- - "'.0: . . A . . . A" . . ,. ,- . ,. ". . :.,:; ~ DI(AIN 1'01(1 wI NEUI'I\J:NJ: 't : FLAPCHU::K .A :, A' ^1 ~"'~1/// . ;- MODEL 10 OSI 05 I-IllI' EFFLUENT PUMP WITH ~;o POWEr< CAIlLE ANI) JIB" IIY.I'A% OHIFICE IN THE DI~CH^I(C;J: HEAD i . I --1_-'1'__ ,'I SIDE V1EW TYP1CAL TWO COMPARTMENT 1500 GALLON SEPTIC TANK D1 c1r:Jwing ~ lJ 91 b IlJ.l. Ol('OfU Sys,rlll'i Jlte. u.s. J',lklll Nfl. 443'J.123 L 1 ,5' CONDUIT TO PUMP CONTROL PANQ 0 fLECTlCAL SPUCE BOX w/CORD CRIPSa FIBERGlASS LID WITH STAINLESS STEELe'!) BOLTS, GASKa, AND OPTIONA/.. INSUlATiON PVC HOSE AND VALVf ASSEUBLYO (size as required) "I- FlEXIBLE PVC HOSE Y Egpe /0 drain 24' I 12" I 01/r TO Jjr ROCK ~ CHECK VA/.. vr PUUP BASIN WfTH GROMMfTS <:) FLOAT ASSEMBLr(!) SUBMERSIBLE PUMP 4) 2" S4ND L[vEL/NG 0 LA'lfR (belaw JO mil PVC liner) SIDE VIEW - TYPICAL SAND FIL TER wI PUHP DISCHARGE, SCALE: NTS ~ P\'C lATrlWO wjOR/FleE SHIELDS AND FLUSHING VALli[ AIR COIL SYSTEM FLUSHING VAL\![ VA/..V[ BOX 0 S4ND (backfi/I be/ween the plywood and the excavated wal/s) J/B" PEA GRA\![L P[RIM[T[R SUPPORrQ FRAU[ (1/2" un/realed plywood) 1/2" - Jj4" ROCK AIR COIL [NO CAP FlUER SAND (refer (1) /0 grado/ion curve) 18'-0" 1J.5"- --27--- 1 - 1/4" PVC MANIFOLD (closs 200 minimum) ~,r ,0- 0- ::, ~ .:: c ~ 0." 4. CLASS 125 SLOTIEO fVC PIPE ~ (1/4" wide slots 2-1/2 , deep ot 4" on center) ~ :r---oQ ~c : :J '-' "" ~ l~ pump~onlrol panel 0 L "" ~ C -8 D C ~ " A / .:"'" '0""" ~""" ~ ~'~"""" '~~ <> 0 ~ 0 ~'" ~ END CAP FROM SEPTIC TANK , 01 1/4" PVC BOOT :'1(. -0- -() :...c--c- -.,J ..J TOP VIEW - 20'XIB' PUMP SAND FIL TER SCALE: NTS /i ~ 15" 00 to droinfield 00 oQ 30 MIL PVC LINER S ORIFICE SHIELD $ 3/4" SC~ 40 PVC lJ,TERALO r (w/ 1/8" dio. orifice) / FLUSHING VAlVEO AND ENCLOSURE 20'-0" DISCHARGE LINE (size os required) 15" PUMP BASIN~ BE.AG {FE!: 1) ~ ..... ....L 10 W .J;.. 01 m ---I 01 /J) 0 ....L o 000 0 0 0 Q 000 0 o ~, ... "'"--..........-.1.-._ ~,4--"''''''......'-''''''"r.- ...A. . --f.. . .... ,'to , , . '-- , " :- .hl "'--f ., I.. -+ --1--"'~' -'- I I -'-_,1, ~,~.'.1'.'~_-' L~_" _l!-,.. ...1 .~'. . 1'1:"" _~~..".'__~-,.=.=_..I.~. ,....f,,_~.-_-.J. _..-_- ~_.--..--. _I....,....~,:.!.-. ]' ..--- l..----r---- _. ....}--' r" - (.--r.... f' . - -(' 'f _I -- i -- 1- - I ~ " '-f- ". '--}-..'...--...---....-.-r-. "....--.., "L ------. '._'_U '''--'. ,.......-.- ......-.-------'1-.-.-, t. ...."--.,, '----,---}. I .--1.- 'I ...+--..1.... "r. ---1-.-.--1--1.--- ~---"I' ....+--- .j-..,-}---.l...--.l---L...--.~---~T...~--.--......i...-... Ul ~ =' --~-r'.'-r:"::~l-~::'~_l~'... C:'.-...-';-. ..... i~--~-:'~-'~:~I"'''~'' )'=-i:~~:~:'':=:J -='.~t.~'~.r-~:=:L~.r"~~:j~~:-:.I~:~~-='~~-(".jL;':--I~~'~~'~ . -..! '~.--_. r - .-.I--."-'}" r "'-1-" . I, " ... _.__,J. ----.-... ;_...._L u'_j -"--1--" "I_u--;'''- -., ~-'--' --f---' , -l~--i---"" .-'-T' " r--- "-'-'1' -I..... 't "...T-....~..... j-.--~_. ,,-.--::.-+----~ ..-- t-. 'or ....'!""'-.r...-+....-.--... (--rOO - -r~"'- ~ .;~.~: ",1, '~::'r-~~l~~~-~':r ':)~., ..~ - ~~.~-..J:::,..-F~~.:l::-:F=-I~~""':,=I~,.:-F::F.~:r::-.-f'~~J-"-=r=~j:','~F::~:~.:.:"'c~:. ~ :--- "j"--- :--..."., '-'-r~'+" -'I -----1--- ..T-....-r-r-....!... -~ ,- ':""T"'-r---"r'--(--'+----I---,; '--i--'-~""-'+----' :.-..-;-.-- f,. . \-...-- ':.... j '-'-,~"" I '....f--.f......l'....T..---..i-.. r-' --..'ii"-.-........-;-..-.r . --, --,--~-."-,-..n+_..-r-...- ._...r...---r..... j'.....{-'.. (" -.r-....-"'.-'..r....-r..-..r--.-.- ''') ".---, .nll-.--'-T--r'- ._1 ___I" ..t--L'--r--'!"'-" () :p ., )> g ,--- ...l----..-....-r---',"r. .~...---l-..........".....-----T---...r--II.-.---.-.. r-' r""'-~-- I. ---!..... __t.____ ~ ~ .' ~ ::~II:~~~' f'.~~] :-'_.: '~~:~I:::::~r ~ ~~?"'-']f' :.. ..'..~-=-~.i='~~:"~ E~'~~l)=::=~E'::'~=.~:F'~F~i'~:{~ ," i'::-'JI'::!=-:~" !~::=: I 1 ' I il ~ . I I : !I '1'- ':.'''-- ...- ..-...-"-....- . . .,' . --u---.... ..' --.."--.--.. --." .. - . _....,_.....)1,.._..J........ '-.......-.-. .. -..:_....... .... ,..!,___. .. _ __J. l I I .,.---.i.. _.~ - -l-'-"~ ...+---- [..." t.--J---'-'j . ---I}"-t-J '''--j-.....!. '~---'i'" f...--- ;... .F~,F,-,,~....~.~L~..J:~~-:J~.~:~ (,} ,', -~ .-~_...;C:...T-::~='l..~...~r--.:J:=-:- J" ...-.1:--=.I..-~]~~.~~~:~=r--: J~. ....r=.T~-'...l--~:T-.-r~--c,.,.: "('::-J~~:'-{' ....... t--=~.: o ;---'I'''--'~-_1.. .....{--. --I.......j---{-.....!.. ...j~.+___J___ .-----!-- r..-J~-=-t .l---=l--,-:r......-{..:,'-c.---.r-:.....i....:... "-"1" i"'''--- - ,'. 11 "'U r-_r-._;-- -", j ,- - .. .--- .- -I'" . L ---II' ,-......,.{--. . ! . "-'1;'-" '... -." -.... .j.......r:..'" '.".. -- .I....-~--. r ...~- ''1'" "{-'--j' .. (..__L... 1/...-- c-- "T'"'''''~''' -f "'''/''---"f'-' ..__..~.._,...,f-...._L._J__-- :;: - ,~:.I-f::I:::: 1 '.J :~T '!::F0 ~:~:J .~J~"'.l':~:=rl::}. J,,:~f::l~j:~t:J,~ ,..~~J--..-l..---l-..Hr.. 1-" --1-' . ~~l"'-'-I --T-- f I "-'''''',' r' 'f"''' I . . {__I._.__.c......." -1."-" ....' -----.T '''J 'Ir'g"'j ,'. ,"-;-- ! .."l----j.......c-- ,'.... ,.....1"... r....r....l.-...i-------...-....~... .......1.___...... ...,......,".. ;--...l-=c.~r.--.~... '0'1-"-1 ~' l ':"-=',-::r"''''(::: '-"-'--r'''r --"'f""''''--' . t - .."----I-....--j-.......,jL .1--..)...+.-- ~ ~ :-~ II'" -I" A'.' - , --1'--' ... h. ,-"" f T ..-- r~- f 'T .. I . :.- .~.., - -.:"....-~,. .-~.!I-.-, -'-'" '''-:''n''n'''-r''''-~, '-1"\ 'T"'''j' ""'''--j''''r-'''-- 'T"..-.--l...--;j-- .'--r---'.......J.---..L ,J.__---'__ :'.'.:~~C '/..'--~~.~.:: "[,'__.1..'''' -~ !.-..' "/,----.,'. _~..- ~('~'_:'" ~'~~'. ':~=.L:_~~ .~ :~-'r:___j .". 1'" .~. ''''I~-''r''-'+--''}'- . +.-----. ; I .. ] Ii ! .', il I I I I I'" ~' ",- --"l-""-'~--'''C- .' ..... -J>-. ;-_..~ '{"---'f"r --j.... I .1"'''' r -.r.....~ .-r.....}';-.. ......T .-(--..: --r' i ----~ . .., -(..I (J) - ....L tv o .. J r: ~: r ),;, :z 11 1;; .... t.> a m -; .1 11: 21::1 EGGE SAHD 8. GRA\,)EL F'.D2/D3 541 485 6532 ",GE SAND & GRAVEL L.L.C. CCB #106727 Phone 541-485-1515 FAX 541-485-B532 90520 CoburQ Road +. Eugene. OR 97408-9467 Sample No. Gradation Report Sampled By: -L \/ Date: ,-.- I f.c - 0 I Time ~ (.:\'\/'1"'\. Project: Customer: . Type of Material: lli Q ~ ~J Tested by L- V Date: " f)-- I ~ - CJ ( Time << f : 1"Q ~........... Tvee of L~t:. ...:;::. ... I \ 7 Remarks: ~W~ ...~~\\~ "j- ~ k~, . I\t, i ?'-;w.;;To';i1i" :>:l~-"1CDl"",~ ~ 1:r::!~f"1'aI..'iil' II!.!.;, 'ff.A' ~., Sieve Size -S/~ q, (?: ! J ~ . I- (0 I <'-d L . "-b~~ , -ro-fl4/ I \' , I I ~_." ~t"'-\ \..IlIr ~Iy,. I I PrC4e.r wc....5 t1 L\.~ ") s .... I 0 <:. -\- I I I I \lJ~II"' . . . Accumulative ~rw~te \^It. I I I , , I I , '.-, 'j-' I Aggregate Wt. Percent Bv Sieve._ __Bmained .0 '" ......,.___.~ q, I S- 1. 0 ? I b d.~ \ ~-='" ~ -.....L91 17 L? \ I LlJ d) ,. <1...J .I (/.(~:/6l I ~ I () I I i I. )- 1 .2.. I'r I lli:.....s-:- '.. _1 . () , i '-l t,?;,'; '1 "-I I I _. 'j I I I Soecffications t cr-o "'=1 S-~/CO 3'0 -!O~ 4- ~ -- 'is'" __.I5~' (~ '3';'f~ I t:J - "-I ,,_. I -, ... I-- I '" ,,, " , ....1.... ....._._ i " I I I I \ ?7Cc9. \"?br.~ \ l' . ( \ ',c? 0 .. . .... I'" _ .,..._...____ i I I I I I I... ... ..,~.t..'II._.... -.fI!'I:':'~' " f: ~--.;..:tIlI.:l\' ...~ 1l{:\""i1',I1IEl!7!~jl ; r;i.r'1 . ~~':l'~~_W~rr."" ":1' l~3';:$' ~.l:. . '~~f "oJ1f.l>1,..~, , . ,!~, lili.siWL,):, p~~tf\~;:I"l~.~ ~~. .~.~" ~Q. Quality aggregates and construclion services since 1965. ~~~.. ..c.~J~~/--~' f~^:;...tR..a-:;:~~~JI::'::~ {;~ J,~~4,:~';c.1!: ~~"i;~;,4~[[~~~;)!), tl'..iit. ftl~....,,-:~!f;t;' - ~'EL:.\;~.,:~.; ~=i\a ',,'i" ,~:y.. ".: '-f.l' .~r: (I..J' ~_: - <0;:1,.. ~;. 11: 21 EGGE ~;(~t.ID 3, C,F:J=i'..'t:.L JE SAND & GRAVEL L.L.C. ,CB #106727 Gradation Report Project: Customer. Type of Material: _O~ Q "f'I.....rl Sampled By: l U . D~e: <;;. I (" ~ () r Time Cj: Oi') Iype of Test: Bemarks~ . c ~ ("10, r---' .. I Sieve Size -j/t I --. ~ -'--1 --'~ "'?CL.., i____ _~o 10-0 PA-v\ : __=:taf'A\ Accumulative AQoreaate VVt. .~ Aggregate 'INt. Percent ~y.(5ve R~abned ~ 3, "" '2 I S- 2,~_~ ,q t f..; ,-'r-- f <=1 'i . ""-_q..LtJJ.o 2 7 I ~ /,., I 'Z C) , 0 _. . tI cJ I , I -12_._5..... l1_L..9 \ ? . 7 ...J I, 'I ~ g n S-f I 7 ... .....____.L.._....,... '.... __)...., ..L ....;. . -', ~ - . I . "_'_" ""_ Phone 541-4S5-1515 FAX. 541-485-6532 90520 Coburg Road + Eugene, OR 97408-9467 Sample No. Tested by I.- U Date: .'.~.:..I fo'-O/ Time J () f to ftJtV\ Percent Pa$Sl~ '- t9 {} 9 ~. c;rf I.a~ iff.:, 14- ! ... ..._ Sp~ific<atjons UIfJ.-1 ~;~!?:6'.. "-'- J,,~-.S'S- i s- - ~ c) "]-/S- - -.. r' .. .0.-__'1 .. .... _..... I I I I .'-'-1-- ! _. ___ ...__.. .h,. . . I !fm.J.... ;-rJ', .t. ~~:jt.. ,~ - l\:..:4-.: I ~~-'lI:;':i;'~.:~rt.:~{ 1;.;:~~:'.l~;;::;;~~~,.;.,\\.. ~. ;=!:j :Ill ~b;;t , t. . r'1~';;"""~'i1f.~.' ....,,!;!.;~.. .';~'<iI.:'-i,L..-:~ . . .' ,". ~:'~ij~ . ~:5Wf', ""~: ~t~U~;:..!!..~~';::;:E..<~~-~a~_~, .::'~1i~o/~::' J.f#, ~~;-'f" qJ,iI~.1'7~..~;1:'=...'rn'==~ ~~~t ~\:iR'~\~:~.' ,.@: . ,,,:::;,,f".~ -3':1.2....,.: ~~., l\:A. ,~~;&..r. ~.. ,:;0.1 ".,.,.' l\ I ." ",~ '0' '.\.. .~, ." ~6::. ~ l~~ f''f~#'~;~JVIL: . ,~_,.." "J~ .. ,....il- - . ;, .'. ..' ce 19$5 nl1~lItv ::Jnoreoates end constructiOfl services Sin . __ TOTAL F'. U..:' , ,'" a t ion s in San d: i t e r :J I ace men t ~ ~ ~ Qii ...J. Fully Buried ~~ -- -,,".:.i~~~.-"..-. ", c c~~{t~~.:, '.~'. '. ':. '~lk~ ~NAL ~o 0" _ __ _-' Sy,rl., ill'-"""l ..........1 al.ed SI-4 AIRlVAY AYErIUE ! "-',.....,",.... ,"". ... . .'. "<llll _ _ 0 _ 0 _ _ ,-;', 11I1111I1I11If1l1f11111 illlllllllllfllllll rlplll tl '.In 1111II111rp]1.! ) '-<i r II [IIItllll 11111 11111111 II JIIH II 1111111111 IIII1II1I1II1I~. :/ - - 11-: 1\1/ ".' SUTl1fRlIN, OREGON '.1 S7.4~9Jl~ TElli'rtOliE: l~~II~ F;"CStM~: 15<'I<5S-r~ (~a:1~t'2~ ..~r~~;::;:-r::::::,.:_:::~:!lb:~) t.. , " ..~. t d"r",r"'I";"';"'i";"'i'''''';'''i",,,'i'''''''''''''''~iJ.' ~}_.' ..III'II;'IIIII".II!'IIIIII1HlilllifllIlJI~; . - ~ *!w - - ~\:._e..nr- (c). Above Grade Mounded -r~;::' "X'.u,.-;+K':;:::" . - ~~ - ~ rO..::.' "'.-.. ..::.~.~;...~: "~"'.' 'N' .'-.' },l"" ~-"-"-";;'-;"-;"-;' -'-.'-;"- _..IGl,.1 ;~ ::.J.~. _" ....;" ~.-."':-O ~.I .....y..v:;...._........ ;--..:.._.. ... ..... _'"."'.._." _" "," ~,':,~ . ,I . . ". ',<' ~ ". -~~. GFov.O .0.' ~11'" ii, i,i,;i'l; i, i,i,i;1 IlIli'llil'.11I1 ill:il,'111I illli.'llllli';I!I! ~ 1 ~ '11.III~ljll '" lill il 1111 11111 [11/11 I rl I 111111111111 ill 1I111~ - - ,~:l ", ~W- - - tCC> ( 'lOp ~S;.~..,O~ 1.J..:,R., IO"Gt' 'f/o,u L,",.x./)."';"'r..C, ~~ 9'l~ rd). Above Grade with Retaining Walls ( =VoY LDAM WV<1> ~~ - - DJ '\ . :-.: ': -.: -.: 'c::'~:- :::;'::":-':'';':-';-':'~"': ;-: II ::':: :': ::::" ::;-::S':; :."7;-_ .-.. i I. 8 . .. ~ g ,.,- \~lil;;,r,;,iliIFIII;,rl'I,ii'(lilrillii'lli,iilliilfl"I II IlIlililll'!,!,! '~m. I ~1!~ljll-llilllill'"'III!lIliIIIIIJIIIIIJIIIIJIIIIIJIi1~ ' - -l~'r"" - ..- '.- -.. . ':.,. ... ,I. CRlCIN,U, GRO<.IrVo e). BOTTOMLESS [No Orainfield Required] SoVIIor:a..... CD'VER J)J"'> -- (1 '" ~."'". ~",",', ...........r--.. :. ~.':. ..c:":.......,..........."'-.-......-.-.r,-.-;,.....~..... .: I - l . . .. .. _ _ .. -'" -".. .. .. __ _ _'".. ._.. .. .. _'". .. .. .. .. ..... woo.. _ .. . .. .. .. .. ... ... I 1 CRGlr<Al. =..r.o \..:. :.~,>:. ;.: ':":'.' ~.:.:' :~.: ~.: ~': ~.: ~ .:~..~~':~.: ~.: ~.:~.:-:.:~. :-:.:~. :~.: -:.:-:.: -:.:~.: -:.: .:.: -:.: .:':.: ': :': ~.::':-:.: -:.: -:.: -: .:-:.; .I FIGURE 2 Methods of Bury C 1/1~/joQ.Onn..'t>~"'I1l'oo!,r..:.. )>~ ::;;. OJ r ;nI :r "0 :r 0 o' 00 "2. :J ro ~. o' 00 Q. :J "0 ~ :;- 00 ::r ~ OJ 0 ;:? ro <0 z :J 00- Q. () Z 0- 0 9 OJ (j; '< (j; 3 3 <5. 0 <5. "0 :J :J OJ Il> :E Il> :J C :J C '< Qo ro ro )> g, T g, ~ Q. 0 r- Q. ~ n. ro iil :J <D .Il> ~ &l en 00 <D en 00 ~ :r .0 ~ :J 0 :J 0 m 0 n <D ~ 0 0 ~ OJ OJ Iii Iii VICINITY MAP N . 5f-. . ." . ~ " . MUST BE IN BLACK INK . . Permit No. QJ - {"jS5Twnshp. I 7 Range e 2- Section~'" _3Tax Lot ~tPY Standard System 0 Alternative Sy~tem ~(Specify Type) . ~ ~-:J( Job Location(StreetAddress) 7t:fre8 5':' A -4T,. 5/./~ Subdivision/Partition # . .. Parce,1 / Lot Block - , i)ETAIL SYSTEM PLOT PLAN (AS-BUILT*) Scale = N * ATTACH MATERIALS LIST FOR~SANITARIAN'S USE ONLY: COMMENTS: o System Approved o Needs Correction o System Disapproved System Capacity gal./day Signature o System Corrected Date Date INSTALLATION RECORD & CERTIFICATEpF SATISFACTORY COMPLETION When signed by the County Sanitarian, This certificate is . evidence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal system at the above location. To request inspection, return all three (3) copies of this form to: Lane County Land Management Division, located in the basement of the Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401. MATERIALS LIST (Required) OAR 340-71-170(3)(b) LANE COUNTY ON-SITE SEWAGE DISPOSAL PROGRAM Office: (541) 682-3754 Fax: (541) 682-3947 SP# ()l-73S~ T-'2 R (5 ~ 7~ ;lL ( (?(YJ Installer Owner A PRE-COVER INSPECTION WILL NOT BE SCHEDULED UNTil. lHIS MATERIALS LIST & AS-BUILT. DRAWING ARE SUBMlll ~D TO TIlE LANE COUNTY ON-SITE SEWAGE DJSPOSAL PROGRAM. SEr He TANK Mf~. , Type/Material. Gallons o Water tightness tested after placement. Results within allowed limits. (Required) D Riser (water tight). inches to ground surface. (Required) D Effluent filter. Mff!:" , , o Anti-buoyancy provided as per mfg.. specs. PISPOSAL SYSTEM {O Std./Saprolite 0 Cap-fill* 0 Pressurized Dist.* 0 Sand Filter* 0 Other * Alternative systems require additional information/inspections. o Curtain Drain: Depth of trench Depth of graveUmedia Outlet location o Effluent sewer pipe: Length Dia. . ASTM o Distribution material: Perforated pipe Dia. ASTM IInfiltratorlEeeZzz drain/other o Drop I Distribution box installed. Mfg. Material o DiSposal Trench Total Length Depth D ,Drain media: Total depth Depth below pipe . Supplier ~ . . . PUMP INSTALLATION RECORD (IF APPLICABLE) . Mfg. & Model HP. . Pump Installer . OPtimp and float switches installed. Gallons I dose o Audible-visual alarm installed & tested. Location .0 Pressure pipe. Dia. D Hydrosplitter MfgJ Supplier ,ASTM , PSI Comments: I understand that I am ....,...~..sible for the satisfactory completion of all required testing, corrections and final cover of the system within 30 days ofeompletion. I certify that construction described above complies with the requirements of Oregon Adrilinistrative Rules Chapter 340 and the permit issued by the LANE COUNTY ON-SITE SEW AGE DISPOSAL PROGRAM. ' INSTALLER SIGNATURE: DATE: ATTACH TO AS-BUILT (W'p) c:\myfiles\mtrls.lst 6199 .