HomeMy WebLinkAboutPermit Septic Tank 1990-12-18
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REQUEST
FOR:
INSTALL SEPTIC SYSTEM
, 'ADDRESSING
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TAll LOT 200 8U8mVI&K*/PAJlnnClN
LOT f PAI'ICEL R.OQl
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LOCATION ADDRESS
KAYDE~ BRIDGE, SPRINGFIELD, OREGON
STRUCTURES HOW ON PROPIiRTY
NO EXISTI~G SRUCTURES
PROPOSED USEl &EPTlC "STALLED
PR IVATE USE
WATER "STALLED
NO. oraTORIES
MO. Of DlPLOYl:mt
CONBTJlUCT1ON COfiIYAW8
OIiBc:R1PTlON or: P\IIOPOIIlD WORK NO. Of' 81!.PRoOua
INSTALL SEPTIC SYSTEM
OIRIiCTlONI TO BlTI "1011 C:OURT1oIOU.8
FROM MOHA~K, GO NORTH ON 31sT STREET TO HAYDEN BRIDGE ROAD, EAST TO 38TH &
HAYDEN BRIDGE
APPLICANT NAME . ADORE..
STEPHEN MILLER,
OWNERS HAUl ~aa
SAME AS THE ABOVE
CONTRACTOR NAME
081'1 LICENSE .
PHONI 746-3185
PHONa
SAME
PHONIl
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NA NA
f MAIL PERMIT TO:
ST!:PHEN MILLER, 2598 HARV~ST LANE, SPRINGFIEI.,I], OREGON
r HAM I ADDRESS
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I hava carafully read BOTH sides of this a
STEPHEN MILLER
q7477
PRt./TN.QAl;;
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-- CA~L ' FOR'NSPEC;'O~S (SEE' ~~'~~ OF FO~~;OR IM;R~~TIONS) 687~0~;
_ SEPTIC permits are good for one year. ALL olher permits expire after 180 days unless Inspections are
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APPROVED BY:
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VIOLA nONS
\ SETBACKS AND onmR _....._.......... OF APPROV ALMUSTBB STRlCIL Y OBSERVED. VIOLATION CANRBSULT IN REVOCATION OPnfiS PERMrr.
crrATIONS MAY BE ISSUED UNDER nm PROVISIONS OF LANB COUNTY'S INPRACTION ORDINANCE AND/OR onmR RHMBDIBS AlLOWED 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 nmnber - Any special directions to the site
PUBLIC OFFICIAL RIGlITTO TRESPASS ON PRIVATE PROPERTY oas D5.OIO
POWER TO BNrnR UPON LAND. TIm COMMISSION, AND ANY OF ITS MBMBBRS, OFfICERS AND EMPLOYES, IN nIB PERFORMANCE OP1HBIRFUNCTIONS, MAY
ENTER UPON ANY LAND AND MAKE BXAMlNATlONS AND SURVBYS AND R.ACI!. AND MAINTAIN nm NBCESSARY MONUMENTS AND MARKERS 1lIERBON.
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place,
UNDERGROUND PIPING INSPECTION: To be made after all underground piping has been installed, prior to any backfllJ.
CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under. floor 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 subfloor.
ROUGH MECHANICAL INSPECTION: To be made after all ducting and gas piping has been installed and prior to being covered,
ROUGH PLUMBING INSPECTION: To be made after all plumbing rough-in is in place, prior to being covered,
FRAMING INSPECTION: 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 INSPECTION: To be made after all insulation and vapor barrieIll are in place, prior to covering,
LATH AND/OR GYPSUM BOARD INSPECTION: 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 fasteneIll 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 electricalirisPections have beerimadeand appro~ed,
FINAL MECHANICAL INSPECTION: To be made just prior to the strucnrre or remodeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPECTION: To be made just prior to the building, structure or remodeled area being occupied.
FINAL BUILDING INSPECTION: To be made after fmish grading and the building, structure or remodeled area is completed and ready for occupancy,
MOBILEjMANUFAcrURED 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 fOlmdation 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,
APPROVAL REQUIRED
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without fust 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,DURlNG WORKING HOURS.
TIllS PERMIT WILL EXPIRE IF WORK DOES NOT-BEGrN wirnIN 180 DAYS, OR iF WORK IS STOPPED OR ABANDONED FOR MORE TIlAN 180 DAYS,
SUSPENSION OR,REV,oCA TI~ ~{AY OCCUR IF TIllS PERMIT WAS ISSUI1D .?~_TIlI~ BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION,
. ,ANYONE PROCEEDING PAST THE PQINT OF REQUIRED INSPECTIONS WILL DO ~O AT THEIR(),WN RISK.
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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 information hereon is true and correct, and that I have a legal interest in the property 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 Slate of Oregon per-
taining to the work described herein. I further certify that if I am not the owner of the y....y....nj. 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 & ALTERNATIVE SEW AGE DISPOSAL SYSTEMS:
When subsurface construction is complete, the permit holder shall notify the County Land Management Division by submitting the installation record
form. An inspection will be made by a qualified sanitarian. If Construction complies 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 within the allotted time constitutes a violation of ORS 454,605 to 454,745 and this rule,
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior pmperty lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
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OWNER OF PROPERTY (i1 not ..me .. above)
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OWNERS ADDRESS (II not ..me .. above)
ZIP
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MAP, PARCEL NUMBER
(Found on tax map. In the A.....m.nl . Taxation D.pt.)
~{OZsnIP E:n; Lc2n 1/4 S.cuon 2;;;5;
Township ~ SKllon 114 S.ella"
T.. Lot
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SITE ADDRES!JfAV[)EN
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MAIL PERMIT TO:
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ZIP
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Land Management Dlv, staff can
not be held responsible for
evaluatIons or recommendations
based on false, Inaccurate or
Incomplete Information
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Exlsllng Buildings or
Improvements on
Property
c::J House _ , 4 ~
Cl Barn' .--"Jj.V"'''
Cl Garage r
Cl Mobile, Home
Cl Shed
SEPTIC INSTALLED
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Water District
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Directions to site
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For Mobile Home
Placement Only
Brand
Year
Size
No, of Tip-outs
No. of Bedrmc
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LANE COUNTY DEPT ENV MGT RECEIPT, I '407490 DATE 121790-
... APPLI CANT MILLER, STEPHEN AD DR 2598 HARVEST LN., SPR I NGFIELD, OREGON.
-TLI 1702190000200' SUBDIV LOT BLK,
I NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES IBLDGS 001 PHONE 746 3185 '
. OWNER NME MILLER, - STEPHEN ADDR 2598 HARVEST LN., SPRINGFIELD, OREGON...
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE, DAY~
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SWF~ : FT. WTR: FT. RAIN:
MECHANICAL FEE
STArE SURCHARGE 5%
PLAN CHECK FEE 251.
FT
LC 407490 SDSS
FEE
100.00
5.00
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SDS ELE PCK
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EST. COMPLETION DATE
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BY RLH
. DEPOSIT **
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TO:
FROM:
SEWAGE DISPOSAL SYSTEMS PERMIT APPLICANTS
LANE COUNTY ENRIVONMENTAL HEALTH SERVICES
You are required by law (OAR 340-71-160) to be in possession of a permit authoriz-
ing installation of sewage disposal system before construction of your septic sys-
tem can begin, In addition, the law specifies that all work on said system must
be performed by the owner or contract purchaser or his regular employees or
a person licensed with the State Department of Environmental Quality to per-
form sewage disposal services, You should read carefully all the specifications
on the installation permit before starting any digging, If you have any questions
regarding installation procedures or specifications or the approved area, call your
area sanitarian at 687-4051 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 State Department of Environmental Quality to per-
form 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 Lane County Environmental Health Services at
687-4051 and we will check for you to see if the individual or contractor you have
chosen is licensed. A file on each licensed installer is available for review upon
request in this office, In addition, the law requires the installer to deliver to each
person for whom he performs sewage disposal services, prior to completion of
such services, a written notice of the name and address of the surety company
which has executed the bond and of the rights of the recipient of such services
as provided by subsection (2) or ORS 454,705, We urQe you to request this from
the installer or contractor you have chosen prior 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 form provided, Submit the completed
form to this office and the inspection will be scheduled, Final insoection for
sewaae svstems cannot be reauested bv teleohone.
Do not hesitate to contact Lane County Environmental Health Services if you have
any questions,
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
125 E, 8th Avenue
I
Public Service Building
(503) 687-4051
I
Eugene, Oregon 97401
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VICINITY MAP
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MUST BE IN BLACK INK
Permit No, fO 7 <1- r 0 Twnshp, _/7 Range 02. Section 17
Standard System ~ Alternative System 0 !t1j.r;;; Type) r
Job Location (Street Address) ;, ~ .. R. ~ 'J!.,.P J
Supdivision/Partition " ~ Par~1 f
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
, Tax Lot
form c55-11
::>...r'rr':l
tot
Scale =
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USE BLACK INK ONLY
FOR INSTALLER'S USE: Trench Depth Gravel Depth Below Tile
Tank Capacity Manufacturer
Measured Distance from Well to Tank From Drainfield Total Length of Lines
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name) certify that a (Mfg,) (Model No,) Pump
and Mercury Float Switch (Mfg, and No,) have been installed with this sewage installation,
Signature Datp
FOR SANITARIAN'S USE ONLY:
COMMENTS:
o System Approved
o System Disapproved
o Needs Correction
o System Corrected
Datp
Datp
System Capacity
galJday Signature
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When signed by the County Sanitarian, Ihis certificale is evi.
dence as per OAS 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 Environmental Health Services, located in the basement of the
Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401.
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