HomeMy WebLinkAboutPermit Septic Tank 1992-8-20
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REQUEST
FOR:
SEPTIC SYSTEM VERIFICATION
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~ TOWNSHIP 17 RANGE 0 2
T5~'4"1DDHA.Y DEN
."'"00 19 . 3' :'1"00
""""405
:II . ,. ,.. PARTITION
LOT I PAlIICEL ROCK
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BRIDGE ROAD, SPRINGFIELD, OREGON
IITRUCTUIlE8 NOW ON PR(lPERTY
EXISTING SINGLE FAMILY DWELLING AND SHED
97L[77
PROPOSED USE SCPTlC WSTALUD
PRIVATE USE
WATEII "STALLED
NO. 011 STORIES
NO. 011 OlPLOYED
COHITRut:TJQN COlJTlYAWI
CESCRlI'TlOl4 OF PROP08EO WORK
SEPTIC SYSTEM VERIFICATION
NO. OF .E"iiiiiOOia
DiRIECTIONS TO llJ{,....1l0ll COUATHOUBB
HWY. 1LO TO MOHAWK,
TURN LEFT TO MARCOLA, RIGHT TO 31sT STREET,
LEFT TO
HAYDEN BRIDGE ROAD, RIGHT TO SITE ABOVE.
....,.PUC...NT NAIIE .. AgORESS
GORDON D. GREEN,
PHO"'il.
741-2482
OWNEII8 NAMa;: .. AcDiiffi
PHONI
'"COiffiiiCTOA NAME
oaR UCDlBI .
PNONIi'
SAME
NA
SAME AS THE ABOVE
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FEES DUE:
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3501 GARDEN AVENUE, SPRINGFIELD, OREGON
97478
ADORERS
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1111111.
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DATE
s;?-Zo -91" _
CALL FOR INSPECTIONS (SEE BACK OF FORM FOR 'vNSTRUCTIONS) 687-4065
SEPTIC permits sre good for one yeer. ALL other permits expIre sfter 180 dsys unless Inspections srs currsnt.
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VIOLATIONS
SIn'BACKS AND 01lII!R w........_..J OF APPROV ALMUST BB S11UClL Y OBSERVED. VIOLATION CAN RESULT IN REVOCATION OFnns PBRMrr.
CITATIONS MAY DB ISSUFD UNDER nIB PROVISIONS OP LANE COUNTY'S INPRACIlON ORDINANCE AND/OR 01lII!R RBMEDIBS AlLOWED BY LAW.
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A MINIMUM OF AT LEAST 24 HOURS AnV ANCE NOTICE MUST BE GIVEN FOR INSPECI10N 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 nwnber - Any special directions to the site
PUBLIC omClAL RIGIIT TO TRESPASS ON PRIVATE PROPERTY ORS ns.oso
POWER TO BN'mR UPON LAND. TIm COMMISSION, AND ANY OF ITS MEMBFRS, OPFJCERS AND HMPLOYBS, IN nIB PERFORMANCE OP nmIRPUNCllONS, MAY
mm:.R UPON ANY LAND A1<.'O MAKBEXAMINATIONS AND SURVEYS ANDPLACB AND MAINTAIN nm NOCESSARY MONUMENTS AND MARKERS THEREON.
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, fue 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 vaperbarrie.. 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 fastene.. are taped and fmished.
ADDITIONAL INSPECTIONS 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 remodeleq 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 completed and ready for occupancy.
MOBILE/MANUFACTURED 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 pe~ 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 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 BE ON TIlE JOB SITE AT ALL TIMES DURING WORKING HOURS.
TIllS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WTI1I1N t80 DAYS, OR IF WORK IS ~wrr~D OR ABANDONED FOR MORE TIlAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF TIllS PERMIT WAS ISSUED owrnil BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
Your signature on the front of this form verifies the following: I HA VE CAREFULLY EXAMINED THIS COMPLETED APPUCA TION, and do
hereby certify that all infonnation hereon is true and correct. and that I have a legal interest in the y....y....~i as owner of record or authorized agent. I
further certify that any and all work perfonned shall be done in accordance with the Ordinances of Lane County and tlte 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 l"-r--OJ' 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 sllbmitting the installation record
form. An inspection will be made by a qualified sanitarian. If consbUction complies with all rules a certificate of completion will be issued to the permit
holder. If consbUction 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 alloned time constitutes a violation of ORS 454.605 to 454.745 and this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior ~'"~-.i lines 10'
Edge ofroad right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAlNFIELD
10'
10'
10'
100'
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Please complete all lines Inside white boxes, If possible.
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OWNER OF PROPERTY (It not urn. .. abova)
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OWNERS ADDRESS (It not ..,.. .. abo.,.)
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MAP, PARCEL NUMBER
(Fourtd on Iu: map. In ..... ~nt . Tuatlon Dept.)
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TOWIIPlp 'ii:;"'" Section 1,. s.cUOn Ta: Lot
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SITE ADDRESS~2- tl-7
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Existing Buildings or
Improvements on
Property
Is) House
c::J Bam
c::J Garage
9 Mobile. Home
}Z9-Shed
SEPTIC INSTALLED
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Water District
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Directions to site from
nearest main Intersect/on
Hwy J Z-b TD I'1",HRw)I. .
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MAIL PERMIT TO:
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ZIP
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.. For Mobile Home
Placement Only
Brand
Vear
Size
No. 01 Bedrms
Weanse #
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Home to:
Land Management Dlv. staff can
not be held responsible lor
evaluations or recommendations
based on lalse, Inaccurate or
,MIl ....2102 Incomplete Inlormatlon .........'....
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1'114-68 02/92
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~F'F'~I~AN~ GREEN; GORDON LANE COUNTY D~b~RE~~4~GAA~b~~I~~ID~E2~a:;2SF'~~~~F~~~1{
TL~ 1702193100405 SUBDIV . LOT BLK
NEW BLDG~YF'E USE R BDRMS 0 UNITS 001 STORIES ~BLDGS 001 F'HONE 741 2482
OWNER NME GREEN, GORDON ADDR 3247 HAYDEN BRIDGE RD.. SF'RINGF.IEL..
CODE AF'F'L NO ACTION DESCRIF'TION S~ FT UNIT COST VALUATION FEE ~:
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LR LC 262792 SDSV
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MECHANICAL FEE
STATE SURCHARGE
F'LAN CHECK' FEE
FT. RAIN:
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