HomeMy WebLinkAboutPermit Septic Tank 1990-3-13
C REQUEST
FOR:
REPAIR SEPTIC SYSTEM
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'TOWNSHIP 17 RANal; 028ECTlOH 19 tI...ECTlON T.u.LOT 1101~D1VISM;lHIPAllll1KlN
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L~JO HAYDEN BRIDGE ROAD, SPRINGFIELD, OREGON
8TRUt;'U'U.a flOW ON PROPIiAT'l'
EXISTING SINGLE FAMILY DWEL[m~~ SHED
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PRIVATE USE
NO. 01 PIPt.OTEQI
COICSTllI.CTIOfiICOlITIVALUI
DUCIIlPllOJt Of' ....WW5V WOIUI:
REPAIR EXISTING SEPTIC SYSTEM (DRAINFIELD)
ClIIlEC'YON8 TO IIlTI '''011 c;oUIlTMOU..
I-J TO MOHAWK TO HAYDEN BRIDGE ROAD
NO. Of' HDROOIa
""UCANT NAlli . ADDRU8
G REG G R E E r! ,
'MONI
726-7150
aWHIRl NAIlS . AODIIIY
RICHARD L. MOFFITT, SAME AS THE JOB
COllIYI'I...I,;,IJR ~""'Ii!.
GREENSUNS'S U!C.
~~llEIP1f8M" EO:INC., P.O. EOX ihU~/j,
(GPI=I=M<::IIM I c: T Mr )
~ HA"I ADDRlsa
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I have cerefully read BOTH sides of this appllca;lo~ ~~d h!1faby, certify that all
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PHON I
ADDRESS ABOVE
t!~i~~~
NONE GIVEN
I'HON&
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SPRINGFIELD, OREGON
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Information
Is true and correct
3-5-QO
DATE
,
.
APPROVED BY: /7
~
DATE~-/~ -reO
,
CALL FOR INSPECTIONS (SEE BACK OF FORM FOR INSTRUCTIONS) 687-4065 J
SEPTIC permits srs good for one yesr. ALL othsr permits expire sftsr 180 dsys unless Inspections srs currsnt.
SHTBACKS AND 01lIIlR CONDm. OF APl'ROV ALMUST BB~~ ~2.~. VIOLATION CANtULT IN RBVOCAll~N OP11tlS Pl!RMrr.
ClTATIONS MAY BB ISSUED UNDER nm PROVISIONS OF LANB COUNTY'S ~N ORDINANCB ANDJOR OTIIBRRBMEDIBS AlLOWED BY LAW.
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 - Job 8ddress - Type of inspection required When it will be ready
Your name BOd phone number - Any specilll directions to the site
PUBLIC OFFICIAL RIGfIT TO TRESPASS ON PRIVATE PROPERTY OKS D5.01O
POWBR TO BNI"ER UPON LAND. nIB COMMISSION, AND ANY OF ITS MBMBERS, OPPICERS AND EMPLOYES, IN nIB PHRPORMANCB OP1HB1R PL........u.."'. MAY
ENTER UPON ANY LAND AND MAKBBXAMlNATIONS AND SURVEYS AND PLACi AND MAINTAIN nIB NBCBSSARY MONUMBNTS ANDMARKBRS "~"
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made Biter exCBvwons for footings Bre complete BOd BOy required reinforcing steel is in piece.
UNDERGROUND PIPING INSPECTION: To be made Biter IlII underground piping hBS been installed, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be mBde lifter BII in-slBb or under-floor building service equipment. conduit. 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 Bfter all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECTION: To be made Bfter BII plumbing rough-in is in plBce, prior to being covered.
FRAMING INSPECTION: To be mBde after the BII framing, flTe blocking, brBCing and roof Bre in plBCe BOd IlII pipes, chimneys and vents ere complete
and the rough electrical, plumbing, and mechanical inspections have been made and approved.
INSULATION INSPECTION: To be made after IlIl insulwon BOd vapor berrie.. Bre in piece, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECTION: To be made after IlIllBthing BOd gypsum boerd, interior and exterior. is in piece but before BOy
plastering is Bpplied or before gypsum boerd joints and fasteners Bre tsped and fmished.
ADDITIONAL INSPECfIONS MAY BE REQUIRED, such as but not limited to;
BLOCK WALL: To be mBde Biter reinforcing is in place, but before BOy grout is poured. The inspection is required for eBch bond beam pour. There
will be no aPl'rovlll until the plumbing BOd electrical inspections hBve been made.and Bpptoved. '.
FINAL MECHANICAJ:INSPECTION: To be made just prior to the structure' or remodeled BreB being occupied and prior ~ o;..,,;ting anyequip!nenL
FINAL PLUMBING INSPECTION: To be made just prior to the building, stti.cture or remodeled erea being occupied.
FINAL BUILDING INSPECTION: To be made after fmish grading and the building, structure or remodeled ereB is completed BOd ready for occupancy.
MOBILE/MANUFACfURED HOMES: An inspection is required after the mobile home is connected to BO approved sewer or septic I
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 elevBtion shBII be certified when required by F100dplBin MBlllIgement
Tiedowns. if required, shBII be installed BOd reBdy for inspection within 30 dBYs after OCCUPBOCY. 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 DURING WORKING HOURS.
TIllS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WlTIIINI80 DAYS. OR IF WORK IS S wrnu OR ABANDONED 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 PAST THE POINT OF REQuniE6 INSPECflONS WILL DO SO AT THEIR OWN RISK.
Your signBture on the front of this form verifies the following: I HAVE CAREFULLY EXAMINED THIS COMPLETED APPUCA TION, BOd do
hereby cenify 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 if I am not the owner of the r~t'-../, my registration with the Builders Board is in full force
BOd effect as required by ORS 701.055, BOd thai if exempt the basis for the exemption is noted hereon, BOd that only subcontractors and employees who
ere in compliBOce 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 pennit
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 satisfBctory completion within the BIIotted time constitutes B violBlion of ORS 454.605 to 454.745 BOd this rule.
SUBSURFACE SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior property lines 10'
Edge of road right-of-wBY JO'
Building foundation 5'
Wells Of other water sources 50'
DRAINFIELD
10'
JO'
10'
100'
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.
.
Please complete all lines inside white boxes, if possible.
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Or.
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Existing Buildings or
Improvements on
Property
lEi' House
c:J Barn ,.
c:J Garage
: v ~bile. Home
Shed
SEPTIC INSTALLED
c:J Yes
c:J No
Water District
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OWNER OF PROPERTY (il not ..me a. above)
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OWNERS ADDRESS (i1 nOI ..m. a. above)
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ZIP
0Rf-E:NS()N'c;., INC
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Directions to site
from Courthouse
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MAP, PARCEL NUMBER
(Found on I.. mapa In the A.....m.nl . TanUon DepL)
T~W~.llIP -J;z n;:o:- ~I" ~.cllon J.! ~11
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Township Rang. Seclion 1/4 SeClion . T... [Ot
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SITE ADDRESS 'Z. 'i 50
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MAIL PERMIT TO:
G~tE:NSIlt-.l"::>
NAMI:;
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AUU"t:~1:>
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For Mobile Home
Placement Only
Brand
Year
Size
No. of Tip-outs
No. of Bedrmt'
License #
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,
.
land Management Dlv. staft can
not be held responsible for
evaluations or recommendations
based on falso, Inaccurate or
Incomplete Information
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