HomeMy WebLinkAboutPermit Septic Tank 1997-05-19,G$-77PERMIT #
BEOUEST
FOB:REPAIR EXISTING SEPTIC SYSTEM
STNI'CTURES Norfl ON PNOPENTYEXISTING STNET,U FAMILY DWELLING AND GARAGE
M
PIoNEER PARKWAi_nAsT To HAYDEN BRIDGE ROAD, ALMOST STRAIGHT ACROSS IS
WAYSIDE LN., SECOND HOUSE ON THE RIGHT.
PAGE SUMMERS, SAME AS THE ADDRESS ABOVE
#103
L@ATtO,l AOOAESS
RAINBOWRES.
D€SC#IP.I OF PffiED l/r/fl(
APPLICAAIT NAME ! ADORESS PH*E 746-8351
O,VNERS NAilEE ADORESS PHonE 7 47-ggo}
CCI.ITRACTOA /|I.ISTALLEP BUILDEn NAIIE
+:?"5a oEMMANUEL CONST.
7
w lERhSTAr.lEO r€. oFsToREs
tlo. OF BEOmTS
LOOP, SPRINGFIELD, OREGON2555 WAYSIDE
PnOPG€DUSE SEPrfr\ETAl.ED NO.OFATPLOYEES CO\6TnUCrrcN@STn/ Ll,E
REPAIR EXISTING SEPTIC SYSTEM
EMMANUEL CONST.,
CURTIS AND
"**t SAITIE
22
I have carelully read BOTH sides ol this application and hereby that all lnformatlon ls true and correct
PRhIT MME tuiga_EMMANUEL CONST.
READ CAREFULLY! Your Authorization ls Based On The Followlng Conditlons
DATEFEES DUE: $APPROVED BY:
GALL FOR INSPECTIONS (SEE BACK OF FOBM FOB INSTRUCTIONS) 687-4065
SEPTIC permits are good lor one year. ALL other permits expire after 180 days unless lnspectlons are current.
LMD 040 Rev. 6/92
PLEASANT HILL1 PHEASANT LN.4 oREGON 97455
isq*E!\.rtrr
JUi$ 11ffifl
SEWAGE DISPOSAL SYSTEM ''AS BUILT'' PLAN
Department ( or Agent) has seven (7) days to perfom an inspsction of the @mpletad mnstruction aftar tha official noti@ dat6, unless the D€partmant (or Agent) elecls to waive the
requestforthepre-coverinspeclion. Pleasscomoleteall threeseclionsoftheformandretumtoLaneCountvEnvironmsntal Health. 125E.EthAve..Euoeng.Oreoon,97401.
SECTION 1: BASIC INFORMATION
Permit #
To Be Completed By lnstaller:
PERMIT ISSUED TO:
Map/T ax Lot #
Name: fun- = n- '? '' a/4y'/Ff " Mailing Address: Zf4?_U,y'14,*'- /. ^r s,.*, ' *, +.r*
PropertyAddress: ,c-y''--4//E: /< y'* '' "- ru1f
TCTAL #: Bedrcoms_ Llr,ing Units __ Basernent: Yes__ No _..
WATER SUPPLY: Public 4lndividual o Community o Other (Name)
SECTION 2: Mate List (ldentify and Iist all materials used in system;
(Date received)
SEPTIC TANK:
Manufacturer
Distance from
o Poly El
lo ft.;ent Sewer
Metal
Total
ASTM
al
DRAINFIELD: A
rotal Linea, Feet-cLA.I-; Drai4field Pipe (ASTM+) 1-rI'.*&'"ader Pipe
Depth Rock Beneafrffi-in t-ine C. in.; Depth nocrblffilEin Line Q in.
Distance of WELL from Closest PortTon of DRAINFIELD O
rnsrrraalqlL
Mfg./Type/Size of Rock Filter M
PUMP SYSTEM:
I (installe/s name),certify that a
(Mfg.)el No mp and Mercury Float
Switch (Mfg. and No.been installed with this sewage installation.
(Complete as Applicable): Working Capacity of Chamber gal. Gallons per Cycle gal.,'WorkingCapacity,'iei:iaii.iingafteiaia;"mhasactivated-ga!'
sig
OTHER: (Materials above
FOR SANITARIAN'S USE ONLY:kVstem Approved o System Disapproved o Needs Correction
COMMENTS:
o System Corrected; Date:Capacity gallday
Signatu re
& CERTIFICATE OF SATISFACTORY COMPLETION. \Mren signed by the County Sanitarian, this certificate is evidence as per ORS
454.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
(over)
,^r" / -/y'-/Z
*)ermit* / 3 5'f-?
********************************************************************************************************************
SECTION 3:
AS-BUILT PLAN OF THE CONSTRUCTED SYSTEM. Show the following: North arrow, septic system
referenced to a fixed point, such as, building foundation or property corner, property lines, wells and water lines
within 200 ft., drive or walk-ways, all buildings, propefi dimensions, streams, ponds, cuts, escarpments (rSO%
slopes). lnclude final grade shots of ends of trenches, distribution box, and septic tank outlet elevation.
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I certify the informdtion provided in this notice is
correct, and that the construction of this system was in
accordance with the permit and the rules regulating the
construction of an on-site sewage disposal system. I
have tested the septic tank for water tightness per OAR
340-73-025(3)
lnstaller (Ptease
it to comply
(Title as shown on DEQ license)
Telephone
License
Bonding
VICINITY MAP
L&
N
,r4
sig nature
and
X]
I
/3 5-t("
(t
*
SEWAGE DISPOSAL
APPROVEDPLA}.I
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0
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=rA^J{\pemit #
AL HEALTH
125 EASTSTH AVENUE
EUGENE, OR O' 4fI'1
/7 z
)
DATE
BY
T
Ff
fF e'r r4t'/' ,tr//- fllez7z/./,r luflEr z h-Eqilrfilzr EE 4/t//atat
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Lu" r<N/hBlIrpq
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Exlstlng Bulldlngs or
lmprovements on
Property
E.House
EII Bam
EEI GarageEl lriobile. Homet= Sh€d
SEPTIC INSTALLEDEl Yes
Ef llo
Water Distric't
{?.Ai^ Bow
Please complete all lines lnslde whlte boxes, lf posstble.
oA
nol tma tl
nol gma D
Ad
ztP
J,YJ- h'{i or\lYr
1
3Cs.r6'IEm--T-
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MAP, PARCEL NUMBER
(FouTd on tu mtDaln th. A.mm.nl I futtlon D.pt)/ 7-a-f- zz, ?,y i rtin;*-,p-- n--w-;-riffi...ffi
Towrhip B.ne. Sction l/a Sction iu Lot
E--nri;t- fr19.- ffit r- -tFE-
Dlrectlons to slte from
4 nrl . .l ..<*- t tl
</.
maln
S'TE ADDFESS
Sro
For Moblle Home
Placement Only
No. ol Bedrms
License #-
Brand
Year
Size
A)LlTn
MAIL PERMIT TO:
A r\)
Dlstance from Moblle
Home to:
Water Sewer/Septic
Land Managemont Div. stalt can
not be held responsible for
evatuations or recommendations
based on lalse, inaccurats or
incomplete lnlormatl149 - 2A2
&,Block
Allowed Use ElYes, : No'Et
t'll4-68 02/92
FLOOD PLAIN
STAFF EVALUATION
lnlormation Bequest Onty E
Verilied ESYes
*; 3 IE coUNTY DEPT ENV MGT REC PT # rr55g7 DATE 051597
APPLICANT SUMMERS, CURT ADDR 2555 WAYS: , LP., SPRINGFIELD, OREGON
TL# 1703224401800 SUBDTV LOT BLK
NEW BLDG TYPE USE R BDRMS O UNTTS OO1 STORIES #ELOCS OO]- PHONE 747 8908
owNER NME SUMMERS, CURTIS ADDR 2555 WAYSIDE LP., SPRINGFIELD, OREGON
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATTON FEE DAYS
BP
BP
BP
BP
BP
PL
MECH
SUR
PCK
sDs
SDEQ
ADM
TECH
#FrXlBATH:
LC L35597 SDSR
FEE SDSR
FEE
FEE
SWR: FT. WTR:
MECHANICAL FEE
STATE SURCHARGE
PI,AN CHECK FEE
FT. RATN:
5z
252
/ sr oTR
FT
165. 00
30.00
24.75
5. O0
CATG: PLN
SEQU:
TAKEN BY RLH
RA sDs
L
EST.
ELE PCK
COMPLETTON DATE
ISS
2 9
DEPOSTT ** 224.75 CK
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TO:
J-
Lane Council of Go -nments
County Sanitarian Sharrel Davison
Courthouse, Florence, Oregon 97439
County Sanitarian
County Surveyor
County Chief Building InsPector
County Public Works Director
County Publie Works--c/o Ted Dietz
BETIIEL SchooL Oistrict //52
4640 Barger, Eugene 97402
c/o Ray Ackerman
EUGENE School District /l4J
200 N. Monroe, Eugene 97402
c/o Dr. L. Perkins
SPRINGFIELD School District ll]-g
525 Mil1, Springfield 97477
c/o Walter Courmons
JUNCTION CITY School- District 1169
320 West 6th, Junctiofl Clty 97448
c/o D. McCoy
McKENZIE School District /168
Finn Rock 9740L
c/o Warren Kenton
PLEASANI IIILL School Distriet llL
Route 8, Box 750
Pleasant 8111 9740L
c/o Joey Acalturri
SIUSLAW School Distrtct //97J
Route 2, Box 4, Florence 97439
c/o Tom Tuttle
SOUTTI LANE'School District /145J
103 S. 5th, Cottage Grove 97424
c/o Raymond Mullen
Eugene Planning Department
City Hal1, Eugene 9740L
c/o John Porter
Sprlngfleld Planning Department
4th & North "A", Springfield 97477
c/o Dick Johnson
City Manager Frank Carlton
Clty I{a11, Cottage Grove 97424
City Administrator Don Dougherty
Clty llall-, Florence 97439
Heceta Beach Water District
P.O. Box 25
Florence, Oregon 97439
Pacific Northwest Bell
LLZ - 10th Ave., Eugene 97401
c/o Bill Marcellus
Eugene Water & Electric Board
500 - 4th Ave., Eugene 9740L
Rinard Damewood
Pacific Power & Light Co.
550 Main, Springfield 97477
c/o Ed Canty
P.U.D. Light & Power
966 Highway 101 N., ll-orence 97439
c/o Campbell
Northwest Natural Gas Co.
931 Oak, Eugene 9740L
Oregon State Highway Division
P.0. Box L269, Eugene 9740L
c/o Dale A11en
City of Eugene Purchasing Dept.
City HaIL, Eugene 9740L
c/o Phyllis Taylor
U.S. Dept. of Agriculture
Siuslar i.lationaL Forest
P.O. Box l-48, Corvallis 97330
c/o Stanley Bennett
Soil Conservation Service
954 - 13th Ave., West, Eugene 97402
c/o Ralph Cleveland
r=t n
I
FROM:Lane County Planning Department
L35 Sixth Avenue East, Courthouse Annex,Eugene 9740L
Fi1lng Fee--$10.00Subject: Division of Property
The Land Deveiopment Revie!,/ Committee will consi<ier the attached
for (preliminary), (f inal) approvaL on
(mirror) ,
-
(orajor) plat
te
Name of Plat:
Instruetions:
r*
Section: 2^ ,4Ll &rp t7 Range 3
send written recommendation to the subdlvider and the secretary of
the Lane County Planning Commisslon at least tr^lo (2) days prlor to
the meeting date noted above.
Please check easements, make any changes necessary and send to
Lane County Planning Officer.
/, oo
rL ll /7ol
Comments:
i
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.fS -U' l';S
\CIES.
SE U4 SEtt4 Sec 22 T t7S R.3 V/.w[t
tANE COUNTY
f.rd
17 03 224 "t
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i KIRK AVENUE
!.. Yo, 17 Ol 22 a I
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20 roo
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CROSBY AVE.
ALLEN AVE
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NOTE sEE CHECKLIST ON REVERSE SIDE
owriER
ADDRESS
TA;( T,oT ffTAOO
Lorene Boehm
2555 'tlaYside Lane
Springfield ,Oregon
7l+6-t+709
TAx LOT # 18oI
H.F. SlJi.lNK
2525 'ilaYside Lane
Spri ngfie Id , Oregon
7t+6-66L1+
TOWNSHIP RANGE
I
I
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IL
oo NOT WRITE lN l HlS SP/cE
MINOR SUBDIVISION
ESSORS t'/'AP l7-
TAX LOT(S)
SECT ION
I
2
J, C, /NARU= L
I*z*Y:r,Z,fr,.1 7'.-.?{i'21
PREPAREO 8Y
i'vcz
sCALEPHOI\E i{UMBER l-l*7 I - lr Z
I
a200
.660,0
I
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.cao
Ttoo II
i
r400
\
DEPAR,TMENT OF HEAITH AND SANIIAIION
LAI{E @UNTY COJRTFOUSE
EUGENE, OREGON
Jut.v eO, l9?l
l{-SO 6OE}ll{,Lortrs.lI Trx Lcrr t8fio & t8ot-O3-8?I
i4*. Le c i,ltutrr, 3tcnrtrnr
Lrffi Cacx?Y h,,Axxtrs Csrrrsaror
Corntrarr
fucrxcr CIrgoor
flrr Loaure tlocxu Mrxoa lrroryrstox
Tne eaoyr of$girttD propc*Ty nAE tfcr. rxvr.$rtcr?Eo ay ?nr8 otF^nrxrr{rliD l$ Haf,tlt elyEr ArprovtL rei TrE ,lrttrLlr?tof 3r trorytgtAL stt-
sunFAct 8:ur8t, ol$io$el 8Y$rt*6 trorlo[9 tult rc yrTtR ts AyAltatLt ?o
f,ACf, LO?.
JOSa (. $T0!{[ft, ii.3.1 0ti.ecton
Eutletro rlo Srxtrlr ror 0rvrs rox
S. B, Rtltrtl R.5.
Sl&:ps
ec i Lorflg &ornr
8))J hJArup: LaNc
$prtrcr rllDr Onrer
IOPY
.G- tiluESTl0ATl0ll
Recr r PT No.T\4/P. . ! R
TAX MtfNO
ANGE 03 SE
'-[8oo-uu
c,sz 4.4
DE lg-03
REQUEST FOR SITE INSPECTION Dnr e
BY Mrru rNe AooRess 1070 Oarl lnq Avc.Trl. No.
Spr lnqf lcld, 0rcaon
OwruEn or PnopeRTy Hr Stze or Pnoe. ll5r x 95t Lgonl Access?Les Uaysldc LancCorseNt or OwNrn?ls pnopERrv conr{,GUOUS TO ANY C I TY L ITq IT?
Ex rsrtNG SrRUcruREs oN Pnopenty
SOURCE 0F WATER SUPPLY: pueLrc SpR t rue Wrru: Dnrluro Dn t ven Due
DESCRIPTION 0F SITE (Drnecrrorus, LANDMARKs, HousE oR BOX NO., t r anv) :
on rprth ottt corncr.Corner of Hayden trldge Uay and Yayslde Lane,
PRoPoSED usE 0F slrE (E.G.r NUMBER oF DrrELLrNGs, coMMERcTAL oR TNDUSTRTAL usE, suBDlvrsroN):
UneamrztNG Anea.
Sprctau PEnurr ARel.
FEE: RE_tilVEST|GATtolt
No.
No.
or Srrrs
or AcnEs-
TOTAL-kc $-
lHyEsTtGATrOll
RESULTS OF I NVEST I GAT I ON :
Tnts ls A PRELTMTNABY REpoRT wHrcH.ooES Nor TNSURE THE rssuANcE oF A FUTURE BUTLDTNePERMlr. At'tv ptANs oR ExPENDtruREs MADE tN RELtANcE upoN THts REpoRT ARE AT youR owN ntsxl
BETORE CONSTRUCTION lS STARTED antNG rHts FoRM ro rHE Burr-orNG ANo SnNrrarroN DrvrsroN ANDMAKE APPLIcATIoN FoR A BUILDING PERMlr. lr rxe pRopERTy rs A poRTroN oNLy oF A TAx LoT, AMETES AND BOUNDS DESCRIPTION OF THE PARCEL MUST tsE FURNISHED. EXACT SPECIFICATIONS FOR THESEWAGE DISPoSAL SYSTEM t/lLL APPEAR oN THE BUILoING PERMIT. Two srrs oF THE BUtLDING pLANs
AND PLOT PLAN l^/ tLL BE REeU tRED.
LANE COU Y BUILDING AND S ATION DIVI
Di le epfq',re/.
/|r a-
U lLDlNc IttspEcroR Saru ttan tar.t Da TE
:-:,:_,:.to*,
ls NoT CoMPLETE wrTHoUT THE SIGNATURES 0r THE BUILDtNG TNSPECToR AND SANITARIAN.
I
D
D
7z-ar
7- -"--?Eo vl s.tr/a 'B
REcE r pr No.
BY
A/z
REQUEST FOR SITE PECT I ON
Metltrue Aoones
I\U^d+\'^
Dnr
NGE ",Wy'CODE
,4b
E
cq
./** 6d42,-
Owxen or PnopEnry StzE or Pnop.
CoNserst or Owuen?ls pn
ExrstrNe S TRucruRES oN PRopeRty
SOURCE 0F WATER SUPPLY: puarrc SpR t No
DESCRIPtrION OF SIT ( Dr necr r orus, LANDMARKs, Hous
Tel. No.
Leenl Accrss?
RTY CONT I G US TO AN crTY Lturr?
r'
!{ell: Dnruueo DntveN Due
rr aNv):b Za/,,ru4)E OR BOX NO..
ez-*-D
/
. t NUMBER OF El,/ELL lNcS collMERC I AL OR I NDUSTR I AL USE, SUBD tV tS tOru ) :
PRaPoW USE 0F S|TE (e.c
'fo/tzut 4d-.nn
Q UaaaNtztNG AnEa.FEE r
Spec r au E r r ARee
RESULTS OF I NVEST I GAT I ON :
No. or Srrts ,/ $_5:AdNo. or AcREs /
TOTAL
TO O'a
fo.
(? ,.,irrr.rrt /4o{ilrn-rta" - l'tr/',':t ut /, ,cl-tJt*'{ l'urt/l"'l*fo'-/
,,,n {'lrils ls A PRELIMINARY REPoRT wHlcht DoEs Nor tNsuRE THE tssuANcE oF A FUTURE BUtLDtNGPtRMir. Awv pUANS oR ExPENDtruREs MADE rN RELTANcE upoN THls REpoRT ARE AT youg ohrN ntsxl
BEFORE CONSTRUCT|ON ls STARTED BRTNG Tttts FoRM ro rHE Butr-orNG AND sanrrarroN DrvrsroN ANDMAKE APPLIcATIoN FoR A BUILDING PERM|r. lr rne pRopERTy rs A poRTroN oNLy oF A TAx LoT, AMETES AND BOUNDS DESCRIPTION OF THE PARCEL MUST BE FURNISHED. EXACT SPECIFICATIONS FOR THEsEI"/AGE DlsPosAL sYsrEM r'/lLL APPEAR oN THE BUILDING PERMtr. Two srrs oF THE BUtLDTNG pLANsAND PLOT PLAN WILL BE REQUIRED.
LAN NTY ILDING SANITATION DIVISION
F*---i-7ILDSarutranraNDnre
THIS REPORT lS NOT C0MPLETE l^/lTHOUT THE SIGNATURES OF THE BUILDING INSPECTOR AND SANITARIAN.
E
crr-o97-01
PLA ,iNING OFFICE
DATE -?-1 \
R