HomeMy WebLinkAboutPermit Septic Tank 1991-7-8
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REQUEST
FOR:
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SEPTIC SYSTEM VERIFICATION
~ TOWNSHIP 17 RANGE 02 SECTION 19 .;.~ TULOY 405 auaQlvCIiIOJI,p,umTlON
'o;L~ro'HAvDEN B R I DG E , ROAD, S P R I NGF I ELD. OR EGON 97 Lill
LOT I'AACEL a&.oac
.TAU~TURE. NOW ON PROPaRTT
EXISTING SINGLE FAMILY DWELLING, SHED
PROPOSED us. SEPTIC .......It.U&'-I
PRIVATE USE
.....,...I.'.'.I.,M_..
....,. 01 aTOND
ND.OI' EIIPl.OftE8
CONITRUCTlOJI COBTIYALUII
~RlPTlON Of'" 1'ROP08U1 WORK NO. or .El)ROOI!Ia
SEPTIC SYSTEM VERIFICATION
~'TWO'BLOC'KS~EAST OF 31sT STREET AND HAYDEN BRIDGE ROAD. IN N.E. SPRINGFIELD
"PPll~NT NAME II ADOREIIB . 3501
buRDON D. GREEN.
GARDEN AVENUE.
SPRINGFIELD, OREGON
9741'6" 7Ln -2482
OWNERI N...... . "ODRIA
SAME AS THE ABOVE
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SAME
COfHRACTOIl NAMiI
NA
~ MAIL PERMIT TO: ~
GORDON D. GREEN, 3:l01
~ NAMI
I hava carafully read BOTH aides
GORDON D. GREEN
~ UCENaa .
PHQNII
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FEES DUE:
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of this s~n su>=~rabY J}1f~~~~ Inf:rmatlon
Is true and correct
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GARDEN AVENUE, SPRINGFIELD. OREGON
97478
ADDREas
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In Balled On The
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APPROVED BY:
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CALL FOR INSPECTIONS (SEE BACK OF FORM FOR INSTRUCTIONS) 687-4065'
, SEPTIC permits ere good for one yeer. ALL other permits expire after 180 days unless Inspections are current.
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VIOLATIONS
SBTBACXS AND 01HBR CONDmONS OF APl'ROV ALMUST BB S11Ucn. Y OBSERVPD. VIOLATION CAN RESUL TIN RBV0CA11ON Ofnns PERMIT.
crrATlQNS MAY DB ISSUED UNDER nIB PROVISIONS OF LANBCOUNTY'S OOlRAcnON ORDINANCB ANWOll onmR RBMBDIES AlLOWBD BY lAW.
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A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following information ready when you call: 687-4065
Permit number - Iob address - Type of inspection required When it will be ready
Your name and phone number - Any special directions to the site
PUBLJC OWlCIAL RIGlrrTO TRESPASS ON PRIVATE PROPERTY OKS ns.OIO
POWER TO RN11!R UPON LAND. nIB COMMISSION, AND ANY OP ITS MBMBERS, OFFICERS AND EMPLOYBS, IN nIBPERPORMANCI! OPnmIR PUNCI10NS, MAY
ENrnR UPON ANY LAND AND MAKE EXAMINATIONS AND SURVEYS AND PLACB AND MAINTAIN nIB NECESSARY MONUMBN1'S ~ MARKERS TIlEREQN.
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 backfill.
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 barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECTION: To be made after alllatlting 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 have been made and approved.
FINAL MECHANICAL INSPECTION: To be made just prior to the structure 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 finish grading and the building, structure or remodeled area is coinpleted 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 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.
APPROVAL REQUIRED
No work shall be done on any part of the building or structure beyond the point indicated in each successive inspection without nrst 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 BE9IN WITHIN 180 DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE TIlAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF TIllS PERMIT. W AS ISSUED ON TIlE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECflONS WILL DO SO AT THEIR 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 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 State of Oregon per-
taining to the work described herein. I further certify that if I am not the owner of the y....y-..J', 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 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 complies with all rules a certificate of completion will be 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 454.605 to 454.745 and this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior y'"y_'" lines 10'
Edge ofroad right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFlELD
10'
JO'
JO'
100'
Existing Buildings or
Improvements on
Property
121 House
[=:J Barn
[=:J Garage
[=:J Mobile. Home
r;;:q Shed
SEPTIC INSTALLED
!Ai Yes
[=:J No
Water District
.E.aat.. t3" W'
J~ Directions to site :1
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Please complete all lines inside white boxes, if possible.
h.oRD6N D.
'rUUH N.-:I.ti:;
GIlIe/Jt:N
OR
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GREEN
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ZIP
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OWNER OF PRO.P~RTY (ir not ...m. a. aboY.)
"HUNe
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OWNERS ADDRESS (If not ..m. as abov.)
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License .
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MAP, PARCEL NUMBER
(Found on tall: m.p. In the A.....m.nl . luetlon DepL)
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Townahlp ~ Section "" Seclion hll Lot
IOWnanlp ~ l:ie<:llon l/4::)ecllon lalLOI
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SITE
ADDRESS
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IIR"'/)EN /3ltf'1 DGE RD.
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MAIL PERMIT TO:
GORTJ6N D. Glf?EE-M
~:::Z7t? I GfiROEW flt/tE"NLJt.=
>?7f?INGFIELD OR
1,;11' /
'17~7'it
ZIP
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.' .....lAND MANAGEMDH DIVISION '.
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ft...jf.4'r'P/S.N BRIDG€
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or Mobile Home
P ement Only
nd
Year
Size ~
Ng..eI1'fp.ou;s--...
~o. of Bed,ms ........
License # ..............
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..TRSye'lfied ... .c::JYes>,Noc::J
.. Allowed Use. .\ C::JYes ,:....:.:No C::J
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Land Management Div. staff can
not be held responsible for
evaluations or recommendations
based on false, Inaccurate or
Incompleto Information
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LOCATION OF SEPTIC SYSTEM
3247 Hayden Bridge Road
Springfield, OR 97477
'5'(wTH 51 [JJ5 DF HDu'ic
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DR.!?!/'!
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The tank was pumped in 1986 and was in good condition. However, the pipes
from the tank to the junction box were later found disconnected, The Company
that pumped and inspected the tank returned and repaired and reset the
junction box and filled the area under and around the junction box with rock
and dirt. To my knowledge, the septic tank and drain field have functioned
well since that time. We have never had any problem with it.
Signed:A~ P.~
Gordon D, Green, Owner
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CATG: PLN
SEQU:
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MECHANICAL FEE
STATE SURCHARGE
PLAN CHECK FEE
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SDS ELE PCK ISS / SI OTR
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EST. COMPLETION DATE DEPOSIT **
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75.00 CK.~
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