HomeMy WebLinkAboutPermit Septic Tank 1994-11-14
-'-;J,<
'-
qLj (-1-12.
(
.
.......f" .
i,';,' PERMIT #
3 cr~5-9~
/~
· REOUEST
FOR:
INSTALL SEPTIC SYSTEM
\
"T"Oo\NSHp RAN::iE .::.~ c:.ir:J;T~r r,;1Jt" SUBDMSlCN/PARTTTl::III
-loc.?noo A;~S ~
154.fp 17 PLACE, SPRINGFIELD, OREGON
STRUCTUHESNOWCfll PROPERTY
NO EXISTING STRUCTURES
.:DA1S::
/'
.
..
L aT""!"?: ""'"
""""""'''''''
SEPTICHS1AUED
WAlEl'I.NSTALUD
NO. OF STORES
NO.OFEMPLOVEa CONSTRucr~COSTNALLE
RESIDENTIAL USE
OESCJlII'T,_.::::-7_,~'NORK
CITY
NO"'''''''''''''
INSTALL SEPTIC SYSTEM
DiRECTIONS TO SITE FROM NEAREST MAIN MERSECT"'"
HAYDEN BRIDGE ROAD TO DELR03E STREET, TO 17TH PLACE.
APPUCANT NAME & ADDRESS
GEMSTONE BUILDERS,
CCHTRACTOR/NSTALlEWBUILDEfl NAME
MEL GARGES
I MAIL PERMIT TO:
GEMSTONE BUILDERS, P.O. BOX #11183, EUGENE, OREGa-J
t NAME STREEf-- ,
~e carefull ead BOTH sides of this appllcat n a d her
~ ;;S,
P E ----
, .,.,.. ...,.,...... . ........... ..~
=..
#82340
'"ON' 744-0061
'"ON' 746-5467
'"ON' 744-0061
OWNERS NAUE& ADDRESS
1""'1"'1< AND JAN M03S, 1310 "T" STREET, SPRINGFIELD, OREGON
o
97440
mv
'"
<
that all Information
'^ ~
Is true .8J1d cf!~ect
11..-:' ~- 9~
, ,
.
Authorization Is Based On The Following Conditions
.'n.'.
...................::....:,..
.,.':.:.::.::.:...,.: .,. '.,.:.::.:.,:':>::,~:.,.
I
FEES DUE: $ ~
APPROVED BY:
DATE
CALL FOR INSPECTIONS (SEE BACK OF FORM FOR INSTRUCTIONS) 687-4065
, SEPTIC permlis ere good for one yeer. ALL other permlis expire after 180 days unless Inspections ere current. I
f LMD 040 Rev. 6/92
<9-l) 'i~
Gv .-u-, C{
v;~ -\-<-
VI'.
-~'.-~.-'l,-",,~'"'~""~--'~.:r~_M~ -~ "\,..-"........--y-"'~--- ;..'\'"'.'......'~...._,~...-'.,.~" ..- ~".'''-lo .;...i..I.;l....-..~. -. .~"..-;... -,"-~'.
,,'
4
, )'
,
_=____!~~.~~1l~:t!._=~__".
-~crrAl1~NS MAY BB ~Sl1ED UNDER niB PROVL!IONS OF lANBCOUNTY'S INFR.ACI1ON oP'ANCB AND/OR 01lIER RBMIIDIES AlLOWED BY LAW.
}, ;' I
"- ........\..) '----"
A MINIMUM OF AT LEAST 24 HOURS AnV ANCE NOTICE MUST BE GIVEN FOR INSPECI10N REQUESTS
.
,
Have the following information ready when you call: 687-4065
Permit number - Job address "0-- '.Type of inspection required\ '--, when it will be ready.
-... ~ \\'\ ''10- - .". j; 'r.
Your name and'phonemnnoer - Any special direCtions to the site
<:.. .'
\:~ \
PUBLIC omClAL RIGHT TO TRESPASS ON PRIVATE PROPERTY oas ns.OIO
POWER TO Bm'ER UPON LAND. nIB COMMISSION, AND ANY OF ITS MBMBFRS, OFFICERS AND EMPLOYES, IN niB PBRPORMANaJ OF nmIR. FUNCTIONS, MAY
E.VJ'ER UPON ANY LAND AND MAKB EXAMINATIONS AND SURVEYS AND PLACE AND MAINTAIN nm NECESSARY MONUMHNTS AND MARKERS nmRBON.
REQUIRED INSPECIlONS
'FOUNDATION INSPECIlON: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND PIPING INSPECIlON: To be made after all underground piping has been installed, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECIlON: To be made after all in-slab or under-floor building service equipment. conduit. piping
accessories and oilier ancillary equipment items are in place but before any concrete is placed or floor sheathing installed. including the subfloor.
ROUGH MECHANICAL INSPECIlON: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECIlON: To be made after all plumbing rough.in is in place, prior to being covered.
FRAMING INSPECIlON: To be made after the all framing, fire 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 INSPECIlON: To be made after all insulation and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECIlON: 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 fmished.
ADDITIONAL INSPECfIONS MAY BE REQUIRED, such as but not limited to; ,
BLOCK WALL: To be made after reinforcing is in place, but before any grout is poured The inspection is required for each bond beam pour. There
will be no approval until the plumbing and electrical inspections liave been m~e and approved.
FINAL'MECHANICAC INSPECIlON: To be m~just priOr to !he s~ture or-renioi:leled area being occupied and prjor,to operating any equipment
FINAL PLUMBiNG INSPECIlON: To be lOade')llSt'ririor,u,~ihe b;';ldiiiUs6-ucture'o'r'remodeled area being oCC~i>iCd.lTI '1 1'.:'- I I
FINAL BUILDING INSPECIlON: To be made after finish gradi;,g and the building, structure or remodeled area is completed and ready for occupancy.
MOBILE/MANUFACfURED HOMES: An inspection is required after the m~bile 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 foundation requirements for mobile homes or as recommended by the manufacturer.
Minimum fmished floor 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.
.. ... \
"-, ',-,s:-,--"" -...' ,:, L - ,_. \"\ "
APPROVAL-REQUlRED.\""~""" \, \ -. '
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without fIrst 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:B!iON TIlE JbB~sITE A~ll'~ES DURING WORKING HOURS. \' -}- ~ \:\~
TIllS PERMIT WIll EXPIRE IF WORK DOES NOT BEGIN WITIlIN 180 DAYS, OR IF WORK,IS STOPPED OR ABANDONED FOR MORE TIlAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF TIllS PERMIT WAS ISSUED ON TIlE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
_.<-.,,, \ ,''>f'" .\-,': ~ t. . "',..".". t.', j'J, ~"", j~' '. }" ,,\
ANYONE PROCEEDING PAST THE POINT O!,R~tg~.~?""IN~fEgIO~1i,~L.~ ~p ~qN~ l'nF;.IR <?~N ,~S~, ',; \
Your signature on the front of this form verifies the following:! HAVEFAREFULLY EXAMINED TIllS COMPLETED APPLICATION, and do
hereby certify iliit~a11 information hereon is true and correct. and th8t-lha~e~ legal interest in the property as owner ofrecord 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 r-"l"'''~)' 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 onlyt.!~bcontractors and employees who
are in compliance with ORS 701.005 will be used on the job. Q~C" ~
SUBSURFACE & ALTERNATIVE SEWAGE DISPOSAL SYSTEMS: ~ ~ ~g.z
When subsurface construction is complete, the permit holder shall notify the County Land Management Diflsigft b:Y1ubmittirrg'th4lefInstallai:ion record
fonn. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certifi~f completi~lr-f(e issued to the permit
holder. If construction does not comply with rules, the pennit holder will be notified, and all corrections shall be made before a certificate of completion
will be issued. Failure to meet satisfactory completion within the allotted time constitutes a violation of ORS ~.fft5'~~ and this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK DRAlNFIELD
From: Interior t'&vt'...u) lines 10' 10'
Edge of road right-of-way 10' 10'
Building foundation 5' 10'
Wells or other water sources 50' 100' t,
,I
~
't,,'\.
,
\
\.-
\
TRS, TL
11 -f) 7,-?-+
SEWAGE DISPOSAL SITE EVALUATION
#?Ot Job Location Al J7~k. PI SAGJ. OR
Written Directions N /q 1-1. ~,., Yr/,..,.Ja .J..o N 1'7u.... PL
S.L # 91- Soq
Subdivision: B.cl:::ll. on
Lot "i:t7~ Block
WATER SUPPLY
sun.
AI... If-_
OWNER'S NAME AND ADDRESS----.f)l""" I"> WD/o-trA h",,,,_ J /51?r-/
/
STRUCTURES NOW ON THE PROPERTY N",~
/"-
P1e-Et..J... 7
PROPOSED USE OF PROPERTY
Phone "7:) q -'7 3~ b
Phone~ -.., ~:J ,_
R-1
APPLICANT'S NAME AND ADDRES~
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; "'"otract purchaser; "otential buyer;
.~eattor or agent. I further certify that (if nol the owner) I am authorized to act for the owner of record. and~owner is aware and approves of this action.
. TEST HOLES READY -L/ov /C{ ,/ 9'+ Signalu," "/ ,/' W- ~ Dal. &". /Q 'i'L
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * OFFICE USE ONLY BELOW THIS LINE * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
THIS REPORT IS NOT A PERMIT FOR SEWAGE SYSTEM INSTALLATION
ADDITIONAL COMMENTS:
~
The area describe~n T~ttachec:. ~Plan dated frjuf'!
<:' - ..... V- . system.
~ A.f!.I..;J ~,~ ~ .-t:- ~..;t/ At ,~
/01JtfTd.l2Jr~~h~r
r
is
~
VII
for a
.
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.
,-
.-
-d/~/ftf
! orEJ
LANE COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051)
C55-32
()/r9~
. -
- DEO AUTHORIZED AGENT
* * * * * * * * . * . . * . * . * * * * . * * * * * * * . . * * * * * * * * *
. .
. 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 regulations in effect at .
. . ,
. the time of application. YOU ARE URGED TO CONTACT YOUR LOCAL .
. PLANNING OFFICE FOR LAND USE REVIEW .
. .
. . . * * * . * . * * . * * * . * * * * * * * * * * * * * * * * * * . . * * *
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 APPROVED, SEE REVERSE SIDE.
.....
- (
~'
<.
,
-\..,;:)
,\
.'
. ...- .," "-""~ ~ ....-- .-'
.. ',~ ._..-', ~ '- '-.,
,
I
'"
j,
. "
.'
. -...
..~ I
-.
.:\
1.,_
"
,- ,
" ,
.. ~. . \,.
,
..
-'.
- ~'.' '.
'\ . ,...
...' .. \ \~ \ ." ...
Lane
ii
>', .
-."
,
~
'-'MEMO
TO: APPLICANT
FROM: LANE COUNTY. ENVIRONMENTAL HEALTH
SUBJECT: CONDITIONS OF SITE APPROVAL
. , .,"".
,f '"
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 basi.s ,that the lot or parcel described above will not be further partitioned or subdivided
and that conditions on~subj~cfor,:a~ja-cent properties have\~nbt..beej, aitered in any manner which would prohibit., '-_
issuance of a permit in accordance'with O.R.S. 454.605 through"454.155 and Administrative Rules.of.the Envlronmental.'C::
qu" ality ComrT!i~ion. 6~Y sul?h subdivision, pa~itioni~g__.or alteratio,Q may ~ v9id this r~~O[L - ,
t'" ,"" \~ _... _ .. ~ -.. _ '\ .~
3. ThTs"~e~6rt is~~~lid untlT 'an '6'll::'Site,;1;~w-age ;ystem iS~'~sta"ed 'pu;s~~r)t; io"'a'.constructlcifi'permit obtained from Lane .
County, or until e~rl~e.~~E(".9..!:I~~!i~n~p'~rSl(~.~!',l?;fO~'!IISSi.~~~r~~~~u~ith:)~~~~~!l',R.~tilce th~rEtof ~}he Department of -'...to;'ll...y"'';'-:-:;~
Enviromental Quality, to the owners"according to Department records or the County 'tax records. SUbject to the I;
foregoing, this repori runs with' the la'nd,jand 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.
.
"
,
\'"
.'
.-..,.....::. ..
'-.
'.
.'
-:' .." c
,.:0... ,.
~')
-
\
.'
-.,
.
ml
.
.
.
.
~ L ~ ':
! ,'.(
.
.
.
.
\0\,1'1
" ,
.,
.
.
.
, ,
. W: 3
APPLICANT NOLTE, TIM
TLI 1703240000707 ~UBDIV
.NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STOIUES
OWNER NME WARTENBEE, DENNIS ADDR NA,
jh~iCODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION
.BP
BP
BF'
.BP
BP
.~~CH
SUF~
.PCK
SI
t; l~ ~0DEQ
.
.CATG:
, SEQU:
TAKEN
.
.
DEPT ENV MGT r,ECEIPT ;; '740509 DATE 111 El'7.
AD DR 219El, LOMOND, SPRINGFIELD
LOT 13 BLI<
'::BLDGS 001 PHONE 729 7326.
'I
I " ~
FEE DAi'~1
.
i
.1:
C'l
..
.
LANE COUNTY
fiFIX/BATH:
SWR: FT. WTR:
MECHANICAL ,FEE
STATE SLmCHARGE
PLAN CHECI< FEE
;
LC 940509 SI
FEE
S1
PLN F~A
SDS
ELE
'PCK
ISS
BY MLC
EST. COMPLETION DATE
FT. RAIN:
:>%
25%
I
S IOn,
1
DEPOSIT !(..)(.
FT
205.00
35.00
24~). 00
J
.
~
~
"
.&
8
'-,'
I, . ~
"
.~
J
~
Jt,
CK
.,
Ii
.1
"
.'
I-
i
t
n.
()
-l
LU
'>
41
~
~
.'
<
(\5
L
~
.'(:
C\;:
'"
\t
~
4J
A
Clrfr..J "/1'/91
'-,
t.
~
~
~
llJ
:s
J-
5
LI
-
:>
{J
:(
ii
\j
.
~
Nt'
-r
/:Jz,.> .' {.
':--.--
~.:.:~---:..,
!,J
~ \
\
l' ',"
(
W ,;
'"
<t
IJl
QI
()
~
0
...,
:>
is
~
.J
...
:J Q
Q
;1 ,
... 11
~
lJ- ,
,
.......
If
I ~
I <t
I Ll
lIl,
!.
G)
J. j '\
.. 'iJ'''''
~ .I.s;lQ) 1:'
sj;q' \Sol
/LS: 0
-
sJ~v ~l/ ,.J
o
Q
'"
I..
(j)
12--30'"
:v'f t;Q
I <j2,3'00
:@
I \..;
, I
I)
o
0'
"
-
~
VERA
..
.oi
I'
...
7..J.s:.tJ
I
I
I@
I 1)..,303
I
!-:
V,
"Z.IS;O
I
I cp_ .301-
It/V
,I.!.;:/
I
r--
I r!A.R:;r::.r=---
I- '
1-- ----
~ s.J. 9</ -5'1)1 I r.?\
Itj 1& \~9
~ I
"Z../;, I'"Q
I
06L <;</-g:;{ I
d 1([9
~ I /~s
1"#1 7.J..ft:;
cv...I'O
..
~
...
...
1:'
l-
e-...
--....
.
, 0
':2:
b tL R.Ol:.<C..-
c:.
"
.'S
IS
l\)
~
'\
151913/5:
1
:0
I
/8"/.!//
~o.b
Y()W;N~A
.
"
..
'"
.,
j'~
Q
..
.:t
r'
\"c, , ql.~lt
"Y
-
t. .:f'
'\~ ~~
~ '~,
- -";""(f)- - ~
...... '"" I
~ :> ,...l,
c:. 'i\'
t 'It.307 .4..
50.0 "
\
8,
\q~
.
I
$J:q2-~o<f !
il f' ~ ~D1~1:
/D\()
c.:v ~:
"-;
~
d
r
1-' @
J:- - 3__4
~;
'\.:
-1 !l.,~1J\"" i .
/oo.O'l;
100,0<-
-@- ~
-,.r
~
&: qq. Sll7
133.99
E.ASE.......E-~r- 0
M
(j)
~'1J-3rh
o
~
"
/13.5>~
"1
,
.. .
,) i\"
.
;nH
.
.
e
.
t/li;.
.
.
.
.
.
. .
.
e
I
H'
J. t ~ I:
e~
.
~
.~
..
.
~
~
,
.~
,1 ~?~
~ .1 Ll.
~
.~
~
.,
.{
.'
W: ;3
APPLICANT MOSS, PETER
.TU; 1703240000706 SUBDIV
",~EW BLDG TYPE USE R BDRMS 0
r~!'OWNER NME MOSS, PETER
. CODE APPL NO ACTION DESCRIPTION
BP
BP
eBP
BP
BP
.
PL
MECH
.SUF<
,:. ll, Ft,', CD' '.s<'
. r _ _ LC 380594 SDSS
.SDEQ FEE SDSS
.
LANE COUNTY DEPT ENV MGT RECEIPT I 380594 DATE 111594
,ADDR PO BOX 11183, EUGENE, OREGON
LOT BLI<
UNITS 001 STORIES IBLDGS 00t PHONE 746
AD DR PO BOX 11183, EUGENE, OREGON
SQ FT UNIT COST VALUATION FEE
.
CATG:
SEQU:
.TAKEN
, f"L.N
1:< A
SDS
1
EST.
ELE
PCI<
ISS
/
SI
OTF<
.
~j467 4 ~
DAye
A
.1
~
I
."
~
.ci
dil
"h
.g
~
el
9 ~
325.00 CI< .,
.1
~f
IFIX/f.tATH:
SWF~ :
FT. WTI:<:
.MECHAN I CAL F'EE
STATE SUI:<CHAI:<GE
PLAN CHECK FF,~E
FT.
RAIN:
FT
5%
2~5%
290.00
35.00
.,
,-
BY F<LH
COMPLETION DATE
DEPOSIT *"
.
;. ~ L ~,
. II
.
. ,.,
......... ....
... "'"
....... .
...... ..
Please complete all lines InsIde whIte boxes, If possible
,.... ..............
.. .., . ...,...
......... .'...'.'..
... ........ .....
.,....:....:.:...::..:..:...:.:-:
(.!rr:m.s7 /JY1e i3u.~/ LJE;e5
yowP: [), ;30~ //I~ 3
YOWEt<<;e/lE- ()If?-
G<tiPF-.--fr1?: 9 :JflfiJ mOSS
i3/7/'("TS~ ~. -A/2
uWne.m.E7'T~~~ fX: ~ L>
Il\Slallorii:lUlldoilCOflliac0r , ~0
MAP, PARCEL NUMBER
(Found on lax ~ In the Aueunwnt. TaxatJon Dept)
LZ -tJ s -'?'j' 7tJ /.,
T own.hlp A.... ........ 1Hs.ctIon T.. Lot
IOWMhlp =oe ........ 114 5KUon ...Lot
Township na;;oo .."'... 114 5eCUon .....LoI
Site Address ! 7 c<:. "7:' -- -
pc, L7'.~,~-,{~~'~E
....................:.::-:: .'.',..
rJ/L
LMD staff can NOT be held
responsible for evaluations or
recommendatIons based on
false, Inaccurate or Incom-
plete Information.
LCPW14g-81Q3
/1-IV-9('
Dale -
(~4/ odj
.-
97~<'/o
L4>
7</1" -5</(, 7
'0"""
97<177
....
, 7~-/~~6j
.t>ono
J r. ,I.J.. BuIldIngs orlnt-
pnwements on the Property
~us.
Sam
_ Garage
_ Mobile Home
Shed
SEPTIC INSTALLED?
_Yes
No
Water District
Directions to site from
nearest main Intersection
~/)71lLJ)v~QE
-In f)Ofo,r
J?-:
/
( r~~0.o
1I~
<?7 <(:<7'0
lip
Fo~oblle Hom/
Pia ment Only
&a
Year """-
Size
No. of Bednns
Ucense' (N . a1w~starts with X)
x- __ ___~__
Dlsta from Mobll~
Ho to:
.... ......
Water