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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. frl\) '/J-' d t H- IiL i {, 4 €r 2Z u-f,- *** *************** 7f' >; f- *********************************************************** 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 AJ "n -0 F 0 0ve 0 7 rtt L ra R,r r,L c9 fo F n {'1 =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 -t0 6?', fc'l6't0, ,l I /\,,- rlil €xzil fau l( *u.1, V1 \A rf',, (r G-11'4 : Jt \ * h'i ,!J c' Lu" r<N/hBlIrpq /24/ gE k*. 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- ,r\^. a s s-Jo t\, ia S^/$-r rTrr-- ]X{,J}!Z 1z /rr 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 l1-63 -f).+t I ! I I I .frar 8Sr l$?t !t $$ S0$flt, lBxtrqtI - 03 . ltE'Lh Tu L+ts l8oo & t&t !rt*. Ltg Hrltr*r $t**strtt L*m &rtrt f,h*mtffi &rutgxtat tt*xtm**r f,e&lr[r S*r*{r firl Lo*trq Btamr Htxoo Swotvrtts ?re rlftt g,t*g*r&Be Fsst(nlt t{ti a€€} }rr€E?la*?&* ir ttt& acr^tTfrftt Ato ts 1+f*f3f eltst.ftsov*f, fo* THt ltLtfrLt.Atlo{ cf ltaolYlourl sl}*+ glffrtt wl,rdc tl*aB$rl sl&?t*3 lrotlele F{tLl( Hrtt* lt AY^lLrttf ?e fr€|t LOTr ,lml €. $IH€SF *rs"r Otttclcn&trrtro *s& $*rrlt*rt&* $tvt*tm $. H. frrslr{ly B.$- $i&r{$ f( r Lmgxc &rtn* ffi$ tl*rcrss Laarc$*fit*gftrtoi 0*rrgx I c@P 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--$10.00Subject: Division of Property The Land Deveiopment Revie!,/ Committee will consi<ier the attached for (preliminary), (f inal) approvaL on (mirror) , - (orajor) plat te Name of Plat: Instruetions: r* Section: 2^ ,4Ll &rp t7 Range 3 send written recommendation to the subdlvider and the secretary of the Lane County Planning Commisslon at least tr^lo (2) days prlor to the meeting date noted above. Please check easements, make any changes necessary and send to Lane County Planning Officer. /, oo rL ll /7ol Comments: i - -.- !-^':Cl'., i' '': .fS -U' l';S \CIES. SE U4 SEtt4 Sec 22 T t7S R.3 V/.w[t tANE COUNTY f.rd 17 03 224 "t .) i KIRK AVENUE !.. Yo, 17 Ol 22 a I DJ!ADr -L*- 20 roo a SEWARD AVE.,. CROSBY AVE. ALLEN AVE 4 Vafcilt'TY.r: -1 .-- | tleao lr,z J 71 r) c,z l o_ F Z. e o I o' oE u,o U' { '-z3o() co trj o fr F F J V lt-,or _r, IIuo tI ta 3800 , iI 39co Gmo l aroo 37@ tl.o atao lLoo a4C10 !€o atao a7@ atoo 5ro2 6!ao rcco o Jroo E t' I I ?.oo c 7!oo BwCq Xoltoal,oaob oLc 7I@ €o 2 llo \ r2OO 260 ,, l9co NOTE sEE CHECKLIST ON REVERSE SIDE owriER ADDRESS TA;( T,oT ffTAOO Lorene Boehm 2555 'tlaYside Lane Springfield ,Oregon 7l+6-t+709 TAx LOT # 18oI H.F. SlJi.lNK 2525 'ilaYside Lane Spri ngfie Id , Oregon 7t+6-66L1+ TOWNSHIP RANGE I I I IL oo NOT WRITE lN l HlS SP/cE MINOR SUBDIVISION ESSORS t'/'AP l7- TAX LOT(S) SECT ION I 2 J, C, /NARU= L I*z*Y:r,Z,fr,.1 7'.-.?{i'21 PREPAREO 8Y i'vcz sCALEPHOI\E i{UMBER l-l*7 I - lr Z I a200 .660,0 I { t .cao Ttoo II i r400 \ DEPAR,TMENT OF HEAITH AND SANIIAIION LAI{E @UNTY COJRTFOUSE EUGENE, OREGON Jut.v eO, l9?l l{-SO 6OE}ll{,Lortrs.lI Trx Lcrr t8fio & t8ot-O3-8?I i4*. Le c i,ltutrr, 3tcnrtrnr Lrffi Cacx?Y h,,Axxtrs Csrrrsaror Corntrarr fucrxcr CIrgoor flrr Loaure tlocxu Mrxoa lrroryrstox Tne eaoyr of$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