HomeMy WebLinkAboutPermit Septic Tank 1990-1-8
"
REQUEST
FOR:
SEPTIC SYSTEM VERIFICATION
""'"
~
~ TOWNSHIP RANGE SECTlON 114 au:TlON TAlI LOT au.Ol\/18IOH I PARTITION
17 03 22.4.1 200
LOCATION ADDRua
35 KATHLEEN COURT, SPRINGFIELD, OREGON 97477
8TRUC;:TURE8 NOW ON PROPIiAn
EXISTING SINGLE FAMILY DWELLING
PROPOlSlW us. aEP'nC ..nAUED W"TEIl ..aTAUSJ NO. ~ NO.. DI' EIII"LOftEa
RESIDENTIAL USE
DUCRlP110N 0lI' PROPOIED WORK
SEPTIC SYSTEM VERIFICATION FOR LOAN
LOT I PARCEL aLacK
CClfClTlluc:TJl)If COBTIYAW8
NO. Of NDROOMS
DIRECTIONS TO alTI ""0lIl COURTHQU8.
COBURG ROAD TO HARLOW ROAD, TO WAYSDE DR., NROTH ON WAYSIDE DR TO WAYSIDE
LOOP, TO KATHL~EN COURT, GREY HOUSE WITH CARPORT
""flue""NT N...... .. ADDRUS
BOB DITEFSEY,
PHONI
746-6320
726-7176
OWNI'" N...... .. ADD"i"
PHO".
C. HALL, SAME AS THE ABOVE
C:OfHRACTOFl HAIlE
OSR UCEltBII: .
1''''0''1
NA NA
l MAIL PERMIT TO:
BOB DITLEFSEY, SAME AS THE JOB ADDRESS ABOVE
~ NAMI AODlllaa
I have carefully read BOTH sides of this a~Pllcatl 'J J~rjIerptiy ~Ify that all
BOB D ITL E F S EY ~I "dtf .<.,J;;:(?//../
PAINTNAMIi - . . ,
NA
~
Information Is true end correct
t
DATE
I
FEES DUE: $
,
Your Authorlzotlon 10 Baoad On' Tha Following Condltlono
.~=
APPROVED BY:
DATE 1-f"...-9n
-----. '
>
CALL FOR INSPECTIONS (SEE BACK, OF FORM FrtPlINSTRUCTIONS) 687-4065
SEPTIC permits are good for one year. ALL other permits expIre aftar 180 days unless Inspections are current.
-'
,-
, . VIOZATIONS' . '
SImIACKS AND onmR CONDmONS OF APPROVAL MUSTBB STRIClLY OBSERVED. VIOlATION CANRBS~ RBVOCAll0N OPllDS PERMrr.
CrrATIONS MAY BB ISSUED UNDBR nm PROVISIONS OPLANB COUNI'Y'S INPRACIlON ORDINANCE AND,OR 011iBR RBMBDIRS AlLOWHD BY LAW.
......
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following infonnation ready when you call: 687-4065
Permit number - Job address - Type of inspection required When it will be ready
Your name and phone number - Any special directions to the site
PUBLIC omClAL RIGIn' TO TRESPASS ON PRIVATE PROPERTY OR! ns.oso
POWER TO BNmR UPON LAND. nm COMMISSION, AND ANY OF ITS MRMBERS, OPPICElS AND BMPLOYBS,IN nIB P8RA)RMANCE OPnmIRPUNcnONS,MA Y
BNmR UPON ANY LAND AND MAKE EXAMINATIONS AND SURVBYS AND PLACE! AND MAINrAIN TIm NBCBSSARY MONUMENTS AND M~ nmREON.
REQUIRED INSPECJ10NS
FOUNDATION INSPECJ10N: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND PIPING INSPECJ10N: To be made after all underground piping has been installed, prior to any backfill.
CONCRETE SLAB OR UNDER,FLOOR INSPECJ10N: To be made after all in,slab or under,lloor building service equipmen~ condui~ piping
accessories and other ancillary equipment items are in place but before any concrete is placed or floor sheathing installed. including the subfloar.
ROUGH MECHANICAL INSPECJ10N: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECJ10N: To be made after all plumbing rough,in is in place, prior to being covered.
FRAMING INSPECJ10N: To be made after the all framing, fife blocking, bracing and roof are in place and all pipes, chimneys and vents are complete
and the rough electrical, plumbing, and mechanical inspections have been made and approved.
INSULATION INSPECJ10N: To be made after all insulation and vapor barriers are in place, prior to covering,
LATH AND/OR GYPSUM BOARD INSPECJ10N: To be made after all lathing and gypsum board, interior and exterior, is in place but before any
plastering is applied or before gypsum board joints and fasteners are taped and llnished.
ADDITIONAL INSPECTIONS MAY BE REQUIRED, such as but not limited to;
BLOCK WALL: To be made after reinforcing is in place, b~t before any groU\ is poured The inspection is required for each bond beam pour. There
will be no approval until the plumbing and electrical inspections have been made and approved.
FINAL MECHANICAL INSPECJ10N: To be made just prior to the structure or remOdeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPECJ10N: To be made just prior to the building, structure or remodeled area being occupied
FINAL BUILDING INSPECJ10N: To be made after finish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILE/MANUFACfURED HOMES: An inspection is required after the mobile home is connected to an approved sewer or septic
system, prior to covering sewer or water lines. for setback requirements, blocking, tiedowns and plumbing connections.
Footings and piers to comply with State fO\D1dation requirements for mobile homes or as recommended by the manufacturer.
Minimum finished lloor elevation shall be certified when required by Floodplain Management
Tiedowns, if required. shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclosure.
. . - - -., - .
APPROVAl, REQUIRED
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without fllst obtaining the
approval of the building official. Such approval shall be given only after an inspection shall have been made of each successive step in the construction
as indicated by each of the inspections required.
APPROVED PLANS MUST BE ON TIlE JOB SITE AT All.. TIMES DURING WORKING HOURS,
TIllS PERMIT Will.. EXPIRE IF WORK DOES NOT BEGIN WTI1IJN 180 DAYS, OR IF WORK IS STOPPED OR ABANOONJlD FOR MORE TIlAN 180 DAYS,
SUSPENSION OR REVOCA nON MAY OCCUR IF TIllS PERMIT WAS ISSUED ON TIlE BASIS OF INCOMPLETE OR ERRONEOUS INFORMA nON,
ANYONE PROCEEDING PA'ST THE POINT OF REQUnlED' INSPECfIONS WILL DO SO AT TliEIR OWN RISK,
... - . ~
Your signature on the front of this form verifies the following: I HA VE CAREFULLY EXAMINED TIllS COMPLETED APPUCATION, and do
hereby certify that all infonnation hereon is true and correct, and that I have a legal interest in the Y' "'Y.....J as owner of record or authorized agent. I
further certify that any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per,
taining to the work described herein. I further certify that ifl am not the owner of the y-..y_..}, my registration with the Builders Board is in full force
and effect as required by ORS 701,055, and that if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who
are in compliance with ORS 701,005 will be used on the job.
SUBSURFACE & AL TERNA TIVE SEW AGE DISPOSAL SYSTEMS:
When subsurface construction is complete, the pennit holder shall notify the County Land Management Division by submitting the installation record
fonn. An inspection will be made by a qualified sanitarian. If construction ~omplies with all rules a certificate of completion will be issued to the permit
holder. If construction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of completion
will be issued. Failure to meet satisfactory completion withiQ the allotted time constitutes 0 violation of ORS 454,605 to 454,745 and this rule,
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior r'-r- 'J lines 10'
Edge of road righ.-of,way 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
,
;..'
Please complete all lines inside
,~&~ O/72PSh
~ ( K 1f1 II L,lj.,y c /.
1UU" ""'un~..
c;Pr~IJ, tP/f.
ct..4!7f /14(.. <-
OWNER OF PROPERTY (H not _. .. aboftJ
aTY
OWNERS AOORESS (et :,ot ..... .. abo..)
t;UHIKA(;IU4i
lownahcp H&n~ ti<<;UOQ 1/4 tioICUOft'
.u....
~w>:.;..,,>:.:.,.'.,-.,
....._"".>:~:.:.-..*"">-,,>>>"'.
-
SITE ADDRESS 5.5" ):',.,.l/1Uh" cr.
YI"~C/..J. c/?
)">>>.>:....:.>>:.;.>>>>:.>....:.-...".-..:v >"'.""'.'>:->>>>>:">>.'''';';''''>>-''>>:'X-:->_;v>'';''>:'>;'
MA}!2JL E' IT TO:
C-,4c.( To
"A "
,/I
'UUHC" c0 /11?1- e.,
white boxes, if possible.
:JA-<5~ - 70
"""1:;
7fr:-(; 3.2(j
t'nUfU:
77'177
ZIP
.v c~ /c
72( -7/76
t'nUfU:
ZIP
....-n.. .
existing BuildIngs or
Improvements on
Property
~HOUS8
to Barn "
I=:J Garage
I=:J Mob<le, Home
I=:J Shed
SEPTIC INSTAU.EO
.120 Yes
I=:J No
Water Oistrid
~ .~
'..,1
DIrections to site
from' Courlhouse
{i'/&../lt tZ/? fb 'd#?tv~ J
17 LJ ;,.; l....J,4 >6t'/.U-&.n-
MnT/7 "A/l...J AV<:/O..l -f1~ Ii Yf/41...l.
L ,-u;,p 'T u r 4-7 #c."U..... c/:
/Yo ~/JP..E55 drv Muu
jlZl V 16<< J-e <,,)1(//
CAJ2,tJoltr
._.'~'W",>;--
,
.< "
\
'T7V?7
ZIP
,
._._~,;J
i/~ J.
4s /(Ti7?L-
:.:.>>>..:."':.>>>_.>:.":.,:...>_.....,,.,,>>""."'..>>'''''''.,-.>:.;~~o.:.:.,...-.o.:,,,,:,:,,,>>:,>,'_,.-.;.o.o:..>>,,,,-.;o.;'_':.h.
'i For Mobile Home
Placement Only
Brand
Year
Size
No, 01 Tip-outs
No. of Sedrms
license :"
1,,;11'
ZIP
,
,
:.__::___:,-:',----','-::----:-- _, :_--- __;:--:. ,":::_------- _: _____',',- _,___n_ :_"_---------_.-' '_',', '''', '_" _:' _,_ ________ _:___:----::= ___--:'::::,_--.:
land Management Oiv. staff can
not be held responsible tor
evaluations or recommendations
based on falso, Inaccurato or
'ncompleto Informatfon
~;
...;v;.:._.,.,....:....
,:;,.,.:.:.;.,.,.:.:,,,.;.:.;...,.;.,.;.:.:_,.,.:.:,.,_:.,_,.:,:;'::,=::"',.._'_..w.....,.
fMttrMlM@ni~';:;:;;~;:4;:;;'" ., ::,ii;dn~;~~iV;
::;::';:::~~:'::;::"':
.......":,::,:.<:;.;
.m........... .
......--.--...
.........,......
m_........._...
.......----...--.
..... ..........
._.m..........
.....-.w.,:_:'...y.......
':~~::::::~
":"':';';'X';""';';';';:~#(;.{:' ;::,:;,,:
"......-T,.;_:.,
;"-.-::':'.-., :;:;:'::;:;:~
.:.;.:-,-;-:.>;-:-,.:-:
:....-.{.,.;.:,:.,_....-.-.-.-,.
.;.:.:.:.,.;.:.;.,.;-,.:-,.,-:,-:.:,:-,-,.'-;.
-------................
........_._._..._._w_w...-.-...:.-...-.
..._.........................~'._...A..
.
~
v
'.. . ...
I ~""-.--
;/
/
,j
~---j5'~.~:'';J~~,~v P04.
.
e
/
/ I
/
I
/ \
/(J
/
~ dJu>>ewtU.;.
, ,
1
,
, '
i/
<
~---j5':zb.w~~.J~~~v ~04
"
.
.... ....
"
, <.........-
.
I
/ f
;/ /
I
/
I \
/ I~
/
, ,
,
I
~ dJu.>>e wru.;.
,
1
e'
W: 5 'LANE COUNtV DEPT ENV MGT RECEIPT I' 4190 DATE 010890 _
APPLICANT HALL. C. AD DR ,35 KATHLEEN CT.. SPRINGFIELD. OREGON
. TLI 17032241002,00 SUBD I V LOT BLK.
NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES IBLDGS 001 'PHONE 746 6320,,"
OWNER NME HALL, C. ADDR 35 KATHLEEN CT., SPRINGFIELD" OREGON'.'
. CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAV.
BP
BP
.BP
:I' BP
" BP
:.
PL
MECH
.SUF(
PCK
LF(
. "
. .
I~' i\i
.
.
'.
.
rf' ~
,
.
.
.
.
n ~
.
e
-
'.'
" r,ATG:
SEQU:
, .TAKEN
.
.
IFIX/BATH:
LC
4190 SDSV
APP
1
BV RLH
RA
.
"
SW'R:
FT. WTF( :
MECHANICAL FEE
STATE SURCHARGE '
PLAN,CHECK FEE
FP SDS, SI
2
EST. COMPLETION DATE
PCK
.
,
,
'.
FT.
RAIN:
.'
5,%
25%
OTH
ISS
3
DEPOS IT' H'
.
.
.
I'll
.
A
.
.
.
"I'
.
.
.
0
.'
r
~
-!
l
'''.
.
FT
.
60.00
'j ~ 1'1
.
.
10
60.00 CK .
.
g
,
.\'
,
.
'1" .~
,~
,
.~
5'