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Home My WebLink AboutPermit Septic Tank 1997-08-08tf a1\a'---\ i F 4 _"trFr A[rtr ri 6tggI (Date received) iY I I HEALI h tt Dopartmont ( or Agont) he3 sovan (7) days lo Portorm an mtpoclion o, tha @mplolad conslrction aftar ths otfcial noti€ date, unl€ss tha Doparlmont (or AEont) otects to waive th6 roquest for the Pro-covor inspodion. Ple63e comolote all thr66 seclions of ths torm and rolum to Lano County Environmental Heallh. 125 E 8th Ave. Euo6^e gggg[32191. SECTION 1: BASIC INFORMATION To Be Completed By lnstaller: PERMIT rssutrn To: Manufacturer Permit *3499:9 b Map/rax Lot#- 1fi1 2.\ - 3 t -1 O t Total Liquid Capacity LOOep gal. . ASrM **HjElistinffi m *eir CllArt. Name ,vtgS I\il ail;- - Property TOTAL #: Bedrooms- Living Units - Baserrre,nr:No WATER SUPPLY: Public { tnOiviOual n Communlty o Other (Name) SECTION 2: Materials List (lde'ntify and list all materials used in system; SEPTIC TANK:x o Metal Distance from Dwelling nt Sewer DRAINFIELD: Total Linear Feet-i54'-; Drajnfleld Pipe (ASTM #) lN FlLTKFIzAleadeq Pipe Depth Roci< BeneaifrEE-uine r{lr} in.; Deptn no.i O.*r orain uinexh in. Distance of WELL from Closest Portion of DRAINFtfIO x l,-4 (ArirM#) BpsV Mfg./Type/S ize ot Rock Filter Material N/A PUMP SYSTEM: I (installer's name)., certify that a odel No mp and Mercury Flcat Switch (Mfg. and No.been installed with this sr-.wage installation (Complete as Applicable): Working Capacity of Chamber gal. Gallons per Oi,cle_gal "Working Capacity" remaining after alarm has activated-gal. sig nature Date g- | -q1 OTHER: (Materials not listed above FOR SANTTARIAN'S USE ONLY: o System Approved o System Disapproved o Needs Correction COMM o System Corrected; Date: sig nature INSTALLATION stem Capacity _ gal/day & CERIIFICATE OF SATISFACTORY COMPLmON. When signed by the County Sanitarian, this certific.ate, is evidence as Per ORS 454.665 ot satisfaclory @mpletion ot a subsurface sewage disposal system at the above location. (over) 1f (Mfg.) Permit# Sqqq ^qb SECTION 3 AS-BUILT PLAN OF THE CONSTRUCTED SYSTEM. Show the following: North arron,, septic system referenced to a fixed point, such as, building foundation or property corner, property lines, vrells and water lines within 200 ft., drive or walk-ways, all buildings, property dimensions, streams, ponds, cuts, escarpments (rSO% slopes). lnclude final grade shots of ends of trenches, distribution box, and septic tank outlet elevation.* *r******************** 1t PU r,Al t4 + t5 z'l go/ NT l" =vb *****t*t********t***t********t***********t** VICINITY MAP g'l _q1 ** lt*l tti**t*i ltt **ti*t** t******* ****t**r.t t* **** *t********t I certify the informdtion provided in this notice is correct, and that the construction of tiris system was in accordance with the permit and the 't:les regulating the construction of an on-site sewage disposal system. I have tested the septic tank for water lightness per OARN340-73-025(3)and fo it to compl'7 lnstaller (Please Pri r((_ Telephone 9ta-r (Title as shown on CEQ license) cr7--c- License N -1 Bonding Company r16d) ?AcL€tL e u^t a 4&' I i ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only toprovide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment-or Revision (LOMA or LOMR) lnstructions for completing this lorm can be found on the following pages. o.M.B. NO. 3067-cf,77 Expires Moy 31, 1996 SECTION A PROPERTY INFORMATION ADDRESS lncluding Apt.,it, Suite and/or Bldg. Nu OR ROUTE AND BOX NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc.) FOR INSURANCE COt\,4PANY USE POLICY NUMBER COMPANY NAIC NUMBER CITY STATE sEcTroN B FLOOD INSURANCE RATE MAp (F!RM)|NFORMAT|ON ZIP CODE Provide the following from the proper FIRM (See lnstructions) 7. lndicatetheelevationdatumsystemusedontheFlRMforBaseFloodElevations(BFE): If.fCVO'29 EOther(describeonback) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: I I i I . L-.1 teet NGVD (or other FIFIM datum-see Section B, ltem 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate lnstructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level I fi 2(a). FIRM Zopes A1-A30, AE, AH, and A (with BFE). The top of the reference level floor Irom the selected diagram is at an elevation'{ otl | 140l?,l.16reetNGVD (or other FIRM datum-see Section B, ttem 7). (b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of :l feet NGVD (or other FIRM datum-see Section B, ltem 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is | . L-] teet above I or below E (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is I i. feet above I or below I lcneck one) the highest grade adjacent to the building. lf no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? E yes I No E Unknown 3. lndicate the elevation datum system used in determining the above reference level elevationr, lI ruGVO '29 I Other (describe under Comments on Page 2). (NOTE: lf the elevation datum used in measuring the elevations is different than that used on the FIRM [see Section B, ltem 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: I y". I ruo lSee lnstructions on Page 4) 5. The reference level elevation is based on' ffi actual construction E construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is:l I 46Ol.l4.teetNGVD (or other FIRM datum-see Section B, ltem 7). SECTION D COMMUNITY INFORMATION 1. lf the community otficial responsible for verifying building elevations specifies that the reference level indicaied in Section C, ltem 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is --l feet NGVD (or other FIRM datum-see Section B, ltem 7) 2. Date of the start of construction or substantial improvement 1. COMMUNITY NUMBEB 465'tt 2. PANEL NUN/BER oo40 3, SUFFIX 4. DATE OF FIRM INDEX t4tsle s 5. FIRM Z.ONE {r 6. BASE FLOOD ELEVATION (in AO Zones, use depth) 45 /. o' FEMA Form 8l -3i, MAY 93 REPIACES ALt PREVIOUS EDITIOT.IS SEE RE\trRSE SIDE FOR CONNNUATIOT.I SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones A1-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management inlormation, may also sign the certification. ln the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features-lf the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, ltem 1, must still be entered. I certify that the information in Sections B and C on this cerlificate represents my best efforls to interpret the data available. I understand that any f alse statement may be punishable by fine or imprisonment under 1 I U.S. Code, Section 1001 . CERTIFIER'S NAME LICENSE NUMBER (or Atfix Seal) L;.rr.'eeirrcg B, Ous"nl ADDRESS COMPANY NAME €- CITY STATE 1 should be made ol this Certilicate for: 1) community oflicial, 2) insurance agent/company, and 3) building owner zlP SIG N COMMENTS: ON WITH SLAB BASEMENT ZONES ZONES ZONES BASE FLOOO FLOOO ELEVATION ADJACENT FLOOD GRAOE ELEVATION AOJACENT GRAOE ADJACENT GBAOE G. The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones Elevations for all A Zones should be measured at the top of the reference level floor. -- * Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member." REFEffENCE REFERENCE LEVELLEVEL R€FERENCE LEVEL t?E(:isTr:llf;!) RLL) SLltivE ,llJLY I.il. li,a.1 LA\/i i.iIi'ii:l ii. r')i-SOi'J Page 2 ON PILES, PIERS, OR COLUMNS AV ZONES ZONES j\oTICE TO: Property owner/applicant for a building permit RE: Fire Protection Service in Easthavqn, Duck Haven and Grand View Estates Please be informed that lots in the subdivisions listed above are without formal fireprotection. The lots will not be officially annexed to the City of Springfield until January 2, 1998, and until then, fire protection will be provide by contract with theCity. Your lot does not have a fire contract. Fire protection is currently being provided to your lot under direction from the City Manager until a fire contract is signed and recorded. Your insurance cornpanv mav not validate a policv without a sioned contract for fire orotection. Without a fire contract, the cost of anv fire response to your lot will be billed to you and may exceed several thousancl dollars for even a small incident. The 1996 rate for protection under a contract is $2.38 per thousand assessed value. This is the same rate that city residents pay for fire service via their property taxes. lf you desire to sign a fire protection service contract please contact Mel Oberst at 726-37 B3 in the Development Services Department. I attest that I have read the above described statement and am aware that my property does not have a fire protection contract. Printed name lnterest in property Pka, /O ,+tlt26 f/b ru Zr./G d"tfi)V Ws4 Ja,s.# ? Ol SZ / Lrf O o't ''/ OSignature Address: \5lAS- Copy: Address File Mel Oberst, DSD Dennis Shew, Fire Department ,1"c,Date /,iu 0-L) Buirding Permit NurTlber: ?6 / 3 2 f