HomeMy WebLinkAboutPermit Septic Tank 1991-10-026B-4
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REAUEST
FOR:SEPTIC SYSTE14 VERIFICATI0T,I
I have carefully read BOTH sldes of thls appllcatlon
LUPE GARDNER
that all lnformatlon ls true and correct
DAIE
READ CAREFULLYI Your Authorlzatlon ls Based On The Fottowl Condltlons
FEES DUE: $APPROVED BY:DAfE
CALL FOR TNSPECTTONS (SEE BACK OF FORM FOR
SEPTIC permlts are good tor one year. ALL other permits expire after 180 days unless inspections are current.
TRUCTTONS) 687-4065
TO THE OT.INER AT THE JOB ADDRE BOVE
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YIOLATIONS
SBTBACKS AND OTHER CONDMONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RBSTJLT IN RBVOCATION OF THIS PERMIT.
CITATIONS MAY BB ISSTJED I,'NDER TIIB PROVBIONS OF LANE COUNTY'S INFRACTION ORDINANC AND/OR OTHR REMEDIES ALLOWED BY LAW.
A MIMMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSI'ECTION REQLIESTS
Ilave the following information ready when you call: 6874M5
Perrnit number - Job address - Typ" of inspection required - When it will be ready
Your narne and phone number - Any special directions to the site
powERroENrER,poNLAND. ",*""i#,:l?"i,51$11*'3Fllt#ffirit::S&lTiffi'#[8ffiff]iffBT-"-r *oprHEIRpuNcrIoNs,MAy
ENTER I,JPC}N ANY LAND AND MAKE EXAMINATIONS A}.ID SIJRVBYS AND PT,,ACE A}.TD MAINTAIN TITB NEGSSARY MONI,'MBNTS AND MARKERS THEREON.
REQI.IIRED INSPECTIONS
FOLJNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
LTNDERGROLTND PIPING INSPECTION: To be made after all underground piping has been installed, pnor to any backfill.
CONCRETE SLAB OR LINDER-FLOOR INSPECTION: To be made after all in-slab or under-flocr building service equipmenq conduit, piping
accessories and other ancillary equipment items are in place but before any concreb 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, p,rior 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, ptumbing, 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 GYPSLIM 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 md fasteners are taped and finished'
ADDITIONAL INSPECTIONS MAY BE REQLIIRED, zuch as but not limited to;
BLOCK WALL: To be made after reinforcing is in place, but before any grout is poured. The irspection is required for each bond beam pour. There
will be no approval until the plumbing and electrical inspections have been made and ap'prcved.
FINAL MECHANICAL INSPECTION: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipnenr
FINAL PLUMBING INSPECTION: To be made just prior to the building, struchre or remodeled rea being occupied-
FINAL BLTILDING INSPECTION: To be made after finish gading and the building, stnrcture or re,modeled rea is completed and ready for occupancy.
MOBILE&IANUFACTURED 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 setbackrequternents, blocking, tiedowns and plumbing connections.
Footings and piers to comply wi0r State formdation requirenrens for mobile homes or as recommended by the manufacturer.
Minimum finished floor elevation shall be certified when required by Floodplain Management
Tiedowrs, 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 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 ttre irspections required.
APPROVED PI.ANS MUST BE ON THE IOB SITE AT ALL TMES DURING WORKING HOIJRS.
T}IIS PERMT WILL E)(PIRE IF WORK DOES NOT BEGIN WTITIIN I8O DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSIoN oR REVoCAfiON MAY OCCLJR IF TIIIS PERtvtrT wAs ISSUED oN THE BASIS OF INCOMPLETE OR ERRONEoUS INFoRMATION.
ANYONE PROCEEDING PAST THE POINT OF REQLITRED TNSPECTTONS WILL DO SO AI',THErR OWN RISK.
Your signature on the front of this form verifies the following: I HAVE CAREFULLY EXAMINED TmS 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 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 !o the work described herein. I further certiff that if I am not the owner of the property, my registation 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 orily subc6nkactors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIVE SEWAGE 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 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 constitutes a violation of ORS 454.605 to 454.745 and this rule.
SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK DRAINFIELD
From: Interior property lines 10' 10'
Edge ofroadright-of-way 10' l0'
Building foundation 5' 10'
Wells or other water sources 50' 100'
Exlstlng Butldings or
lmprovements on
Propertyffirsel-1 Barn
EIl Garage
E tvlobile. Home
E SheO
SEPTIC INSTALLEDl-l Yest-] No
Water District
Please complete all lines inside white boxes, if possible.
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License #
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Two Copies of Plans
Three Copies of Plot Plans
Mech/Plumbing Checklist
Legal Interest Document
PIan Check Info Sheet
SECTION1!MiSHI P /,F ^*"'a 2'
CITY
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TION PROPOSED USE OF PROPERTY
[-l Reside-ntiaI
T commerciar I eruri-.
Industrial
DECI,ARED V
Proposed
isting
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have the following legal interest in the property
I f:rther certify that any and aII woxk Perfomedpertaining to the work described herein, and that
ther certj.fy that registration with the Builder's
No occupANcy witL be made of ey structure without the pemission of the Building Division. f fur-
Board is in full force and effect as required by oRs 701.055, that if exempt the basis for exempti
employees who are in conpliance with ORS 701.055 will be used on this project- I IIAVE READ AND
, andI HAVE CAREFULLY EXAI'IINED THE COI,IPLETED APPLICATION FOR
APPI,ICATION THOROUGHLY
o attachedwf,dence authorirhev1ragentIor,.theand ofLaws Statethe of onbeCoutyOregshal
certify that all infomation hereon is true and correct, and that I
is noted , and that only subcontractors ud
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION HAS BEEN BASED ON THE FOLLOWING CONDITIONS:
#ffi"=
CO!1}IENTS:
Date:
I pr,aus EXAMTNATToN:
COT1}1ENTS:
Date:
c,L
Yes No
UseTypeGroup
1n
FLOODPLAIN: In flooal hazard area?
B. P. #s. r, #
E*"EYes, SEE ATTACHED SHEET.
Parce1 *ParceI sizePartition *
COM,YENTS:
Minimum
Installation Record Issued?
Date:
Date:
Lineal Feet
of Drainfield
Gallon
Tank
I pmt':Nruc,zzoNrNG: zone
c ._L, srde
Maximum Depth
of Trenches
ToTAL VALUATIoN $CONSTRUCTION AUTHORIZED BY THIS PERM]T
Sq. Ft.
Fixed FeelUnit Cost
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INFORMATION
Floodplain Fee $
Subsurface Fees $
Building Eee $
Ilech/Plmbg Fee $
Pr ans Check Fee S
State Surcharge $
DEQ Surcharge $
TOTAL FEE $$
De ption
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IAL/DESIGNEE (peT ORS DATE
OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687-4061,LANE COUNTY c ttr-zs
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SETBACKS AND OTHER CONDITIONS OF APPROVAL MUST BE STRICTLY OBSERVED. VIOLATION CAN RESULT IN REVO-CATION OP THIS PERMIT, CITATION UNDER PROVISIONS OF LANE COUNTYIS INFRACT]ON ORDTNANCE, AND/OR OTHERREMEDIES ALLOWED BY LAW.
WHEN READY FOR INSPECTION,ffiuof inspection, when it will
CALL 687-4065. A MTNTMUM OF AT LEAST 24 HOURS ADVANCE NOTICE FOR INSPEC-. Have-=EE--rorrowing information ready: permit number, job addreis, typebe ready, your name and phone number, and any speciar diiections to site.
BUILDING DIVISION
REQUIRED INSPECTIONS:
1. Foundation Inspection: To be made after trenches are excavated and forms erected and when aIImaterials for [he foundatj-on are delivered on the job. Where concrete from a central mixingplant (commonly termed ttransit mixedr') is to be used, materials need not be on the job.
2 Concrete SIab or Under-Floor Inspection: To be made after all in-slab or under-floor buililingEE?EIce eqEl-pmentl conEuft, plpErg accessories, and other ancillary equip-ment items are inplace but before any concrete is poured or floor sheathing installed, including the subfloor.
Framing & Insul-ation Inspections: To be made after the roof, a11 framing, fire blocking, andbracing are in place and all pipes, fireplaces, chimneys, and vents are complete and al1 roughelectrical and plumbing are approved. A11 wall insulation and vapor barrier are in place.
Lath anVor Gypsum Board Inspection: To be made after all lathing and gypsum board, interiorand exterior, is in place but before any plastering is applied and before gypsum board joints
and fasteners are taped and finished.
5. qiqql Inspec.tj-on To be made after the builtling is complete and before occupancy.
APPROVAL REQUIRED. No work sha1l be done on any part of the building or Structure beyond the pointindicated in each successive inspection vrithout first obtaining the approval of the building official.Such approval shall be given only after an inspection shall have been made of each successive stepin the construction as indicated by each of the inspections required.
NOTE: AlI building permits require inspections for the work authorized, such as but not timited to:
A. Block Wall: To be made after reinforcing is in place, but before any grout is poured. ThisIE-specEIon is required for each bond beam pour. There will be no approval untit the plumbingand electrical inspections have been made and approved.
B. Wood Stove: To be made after completion of masonry (if applicable) and when installation iscomplete. rnstallation shall be 1n accordance with an appioved, nationally recognized testingagency and the manufacturerrs installation instructions.
C. Mobile Home: An inspection is required after the mobile home is connected to an approvedsewer or septic system for setback requirements, blocking, footing connection, tj-edowns,skirting, and plumbing connections.
1. Footings and piers to comply with State foundat.ion requirements for mobile homes or asrecommended by the manufacturer.
2. Mobile home minimum finish floor elevation shall be certified when required by a flood-plain management }etter.
3. Mobile home tiedowns, when required, and skirting shall be installed and ready for inspec-tion within at least 30 days after occupancy. Tiedowns and skirting sha1l be installedper enclosure.
D. Swimming Pool: Below grade when steel is in place and before concrete is poured. Above gradewEen pool-Ts installed.
APPROVED PLANS MUST BE ON THE JOB SITE AT ALL TIMES DURING WORKING HOURS. THIS PERMIT WILL EXPIREIF WORK DOES NOT BEGfN WITHIN 180 DAYS, OR IF WORK TS SUSPENDED OR ABANDONED FOR MORE THAN I8O DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERITIIT WAS ISSUED ON THE BASIS OE TNCOMPLETE OR ERRONEOUS
INPORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQU]RED ]NSPECTIONS WILL DO SO AT THEIR OWN RISK.
SUBSURFACE AND ALTERNATfVE SEWAGE DISPOSAL SYSTEMS:
Permj-ts shall be effective for one year from the date of issuance.
Upon completing the construction for which a permit has been issued, the permit holder sha11notify the Lane County Department of Planning and Community Development by submitting theinstallation record form. The Department shall inspect the construction to determi-ne if itcomplies with the rules contained in this division. If the construction does comply with suchrules, the Department shall issue a certificate of satisfactory completion to the permitfholder.If the construct.ion does not comply with such rules, the Department shall notify the permitholder and shaII require satisfactory completion before issuing the certificate. Failure tomeet the requirements for satisfactory completion within a reasonable time constitutes a vio-lation of ORS 454.605 to 454.745 and this ru1e.
Setbacks - Subsurface Sewage Disposal
Septic Tank
10 r
l_0 r
5q
50 '
Drainfield
3
4
I
)
Interior property lines
Edge of road right-of-way
Building foundati.on
We1Is, other water sources
10r
10r
r0!
100 t
From:
Lrrx: COurty
ACTIVITY INFORMATION SHEET
COMPLETE THIS SECTION. INCOMPLETE FORMS t,JILL BE REJECTED!@
C"u.dr,:*Ur q-a
PENS0N MAKING REQUEST
4ro NesT A)54at /n*PcL
MAILiNG ADDRESS I
( Ql+tt 9 t./l
CIT STATE ZIP CODE
3!3_-_5L 33 7)l' ^,f ttQ
HOME TETEFHOIEtr-
'7fl"'7_
BUSINESS TELEPHONE #
2 PRoPERTY ADDRESs 54
trUSINESSTELEPHONE #
/rn oyt P L
( iF DIFFERENT F IN
3 ruae B PAneEL NUMBEFI (from tax maps in Department of Assessment and Taxation
or from tax statement)( REQU IRED INFORI4ATION)A O}cT
TOI^INSHIP RANGE SECTION
/8eD_Tmm'TGFoR PARCEL #TONING
MINSETP_ MNGE SECTION @ ZONING
mNSFTp SN-GE SEITffN ffi ZONING
ACRESTOTAL CONT I GUOUS PROPERTY I N SAME OI,JNERSH I P :
4 SUBDiVISI0N (if applicable)LOT BLOCK
5 REQUEST (state exactly what you plan to do)
6D ECTIONS TO SITE
FOR S USE ONLY **
ZONE/LAND USE
BY : DATE:-TIME IN i- OUT:-
NUMBER
DATE
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LAND MANAGEMENT DIVISI0N / 125 E. 8th AVE., EUGENE' 0R 97401 / 687-4061
I
H0ME TELEPHONE #
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