HomeMy WebLinkAboutPermit Septic Tank 1995-05-17a,I r(n t?t,#
REOUEST
FOR:
READ CAREFULLYI Your Authorlzation ls Based On The Following Condltlons
APPROVED BY:DATEFEES DUE: $
oALL FOR INSPECTIONS (SEE BACK OF FOBM FOB INSTBUCTIONS) 687-4065
SEPTIC permlts are good tor one year. ALL other permits expire after 180 days unless inspectlons are current.
LMD 040 Rev. 6/92
@iioesotthisapplicationandherebycertifythatallinformationistrueandcorrect
OATESigMture
VIOLATIONS
SBTBACKS A}{D OTHER CONDMONS OF APPROV& MUST BB STRICTLY OBSERVTD' VIOIJ|TION CAN R'ESI''LT IN RBVOCATION OF THIS PERMIT'
cITATIoNs MAY BB rssUED UNDEa, THB PROVUIIONS OP LANB COTTTTTY.S N.TTNEC'TOX ONDINAI{CE AND,OR OTI{EII RBMBDIES AI.I,WED BY LA.I[,.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GTVEN FOR INSPECTION REQTJESTS
Ilave the following information ready when you call: 6874Ms
Pernit number - Job address - Type of inspection required - When it will be ready
Your name and phone number - Any special directioru to the site
:
PI'BLIC OF'FICIAL RIGIIT TO TN,ESPASS ON PBIVATE PN,OPERTY ORS 21S.OTO*ffi :,ffx;rffi ffi ffi ",ffi :I#trH#ffiHffi ffi ffiTffi rffi ff ffi HTffi #'
REQI.NRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
LINDERGROUND 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 ufidsr-floor building service equipmeng conduit, piping
accessories and other ancillary equipment items are in place but before any concrete is placed or floor sheathing insratle4 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: fo be made after dl insulation and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECTION: To be made after dl lathing and gypsum board, interior and exterior, is in place but before any
plastering is applied or before gypsum boardjoins and fasteners are taped and finished.
ADDITIONAL INSPECTIONS MAY BE REQTIIRED, such. as but nor limited ro;
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 app,roved.
FINAL MECHANICAL INSPECTION: To be made just prior to the structure or remodeled area being occupied and prior !o operating any equipment.
FINAL PLUMBING INSPECTION: To be made just prior to the building, struchre or remodeled area being occupied.
FINAL BLTILDING INSPECTION: To be made: after finish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILEAiIANUFACTURED 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 requirernents, blockhg, tiedowns and plumbing connections.
Footings and piers to comply with State formdation requirements for mobile homes or as recommended by the manufacturer.
Minimum finished floor elevation shall be certified when required by Floodplain Management
Tiedowru, if required, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclosure.
APPROVAL RDQIIIRED
No work shall be done on any part of the building or structrre beyond the point indicated in each successive inspection without first obtaining the
approval of the building official. Such aprproval shall be given only after an inspection shall have been made of each successive ste,p in the construction
as indicated by each of the inspections required.
APPR.OYED PI.ANS MUST BE ON THE JOB SITE AT ALL TIMES DIJRING WORKING HOI,JRS.
THIS PERMIT WILL E)(PIRE IF WORK DOES NOT BEGIN WII}IIN 180 DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN ISO DAYS.
SUSPENSION OR REVOCATION MAY OCCI.'R IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
AI''IYONE PROCEEDING PAST THE POINT OF REQLIIRED INSPECTIONS WILL DO so AT THEIR OWN RISK.
Your signature on the front of this form verifies 0re following: I HAVE CAREFULLY EXAMINED THIS COMPLETED APPLICATION, 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 thal 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 il I am not the owner of the property, my registration with the Builders Board is in full force
and effect as required by ORS 701.055, and 0rat 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. :r,'
SUBSURFACE & ALTERNATM SEWAGE DISPOSAL SYSTEMS: ia ' '' " '
When subsruface construction is complete, the permit holder shall notify the County Land Management Division by subm[tting thg inrtallatioll.record
fory. { inspection wil be made by a qualified sanitarian. If construction compliis with all rulis a cerificate of compledbi *nt" issued tci't}re 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 constirutes a violation of ORS 454.ffi5 te. f"Z+S and this rule.
SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK DRAINFIELD
From: Interior property lines 10' l0'
Edge ofroadright-of-way 10' 10'
Building foundation 5' 10'
Wells or other water sources 50' 100'
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IN BLACK INK
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DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
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USE INK ONLY
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DT FOR INSTALLER'S USE: Trench Deptl
Tank Capacity lOOg Manufacturer
Measured Distance from Well to Tank
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From Drainfi
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON T
I (installer's name)certify that a (Mfg.)
and Mercury Float Switch (Mfg. and No.)
Signature
FOR SAN ONLY:
COMMENTS:
System Capacity gat./day Signature
I Depth Below Tile t ,.
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Total Length of Lines
IS INSTALLATION:
h
(Model No.)
have been installed with this sewage installation
Pump
Date
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Approved System Disapp :l Needs Correction
Date
Date
INSTALLATION RECORD & CERTIFICATE OF FACTORY COM ON When signed by the County Sanitarian. this certificate is evi'
dence as per ORS 454.665 ol satisfactory completion of a subsurface sewage disposal system at the above iocation
To request inspection, return all three (3) copies of this form to: Lane Counly Environmental Health Services. tocated in the basement of the
Public Service Building, 125 E. 8th Avenue, Eugene. OR 97401.
Permit No./617-es
Standard System
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