HomeMy WebLinkAboutPermit Septic Tank 1988-08-19,)68- {ffto
Lane County Authori za,ttott for'
REINCATE Dfl STING DRAINFIELD
FOR OFPICE USE ONLY
ir""r- ' " 7Applica
Permit
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RAIIGE
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SECTION TA}: LOT
2500
flour oF
S'JBDIVISION/PARTITION (if applicable)LOTIPAir( x:BI,OCK
'RCPOSED
USE OF PROPERTY
l-lrndustrral
f]e,.,uri.
T,OCATIOIJ ADDRESS ztP
1424 Yolanda
,Y ON
North to I-105
(-- I',l'Y
fami dwelling
east to Mohawk Road
1d, Oregon 97477
I{ATER SUPPLY
ADDRESS
OF
na Rainbow
D-SCRIPTION OF PROPOSED I"]ORK - BI] SPECIFIC
Proposed
Exisna
O;INERIS NAME
na
otl !}.1P
Edr/rard L. Guiley, Sarne as the job address above
drain field
TELEPHONE NUMBER
747-3279
CCNTRACTOR S NAME AND OSR #
Burt l,Vatson I
TELEPHONE NT]MBER
None Given
t to the o\.vner aboveIUail +l n t{.?ne
TELEPHoNE NIJMBER
aII infoiratiot)
ttv pe
authori zed
of Lane
r tlAvE CAREFULLY EXAMTNED THE cot'TpLETED Appl,rcATrou !'oR pERMrr, ar,J ,to r.rrcrr,
DATE
NA}IE (pLease print)
use
, that if exempt the basj.s for exemptid on this project. I HAVE READ AND
fothe interestIegalllouing tn the property of reco d C(,Irr_Efo,r..certif:rther tha!andfy al workany perfomed s hal donebe an OI da:rr i:h tirta i theto deworkpening cribed herein thatand OCCUPANCYNO wi1 be nadecetherrti.thatfy regi s tration theth 1deBui r Board ln1S torceful I dnd ffect reqI5notedheonreandonthatubcontractorsildarewhoemployeesWInceoRsth 70compli
CHECK.ED THI APPI,ICATIONS THOROUGHLY
is true and correct, and that I
the Laws of the State of Oregon
Eduard L. Guiley
of the BuiLding Division. I fur-
ULLY. YOUR AUTHORIZATION 'IAS BEEN BASED ON THE FOLLOWTNG CONDTTIONS:
8/17 /88
rnstallation Record Issued? ! v." fl N"
Installation Gallon
I er,eus EXAMTNATToN:Use
CO}4}!ENTS:
DaLe:
Date RLH T
coll}tENTS t,*ffi
tr
Specifications: Tank
&&^.t tuDatet /9 tu
SANITATION: S. I. *B. P. #
READ THIS SECTION CAREF
UGB PRING'IELD.
rear
I pnnuruc,zzoNrNG Parcel size [&Zone na
Lineal Feet
of ttrai nfield
l'laximun Depth
of Trenches
coi$lENrS: I(c PLAIINING ACTION REQ,UIHD.
Partition #_ parcel #
"o, =ida interrorMinimun Setbacks, CL, f.ort
(,
BY BUILDING ICIAL,/DESIGNEE Der ORS 80
COUNTY DEPARTMENT OF PUBLIC WORKS LAND MANAGEMENT DIVISION
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
SEE REVERSE FOR INSPECTION INI'ORMATION
PERMIT
-4061,
c14-25 R*
lflnesidential
[l cc,nnercial
r
swiminq pool: Below grade when steel i.s 1n place and before concrele is poured.
ilhen poof as rnstalled.
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SETtsNCiiS A:iD OT:I:R CC::DITIO::S O' APPROI,'AL }lUST B5 STRICT:,'J O!:9R,!.''D. VIOLATION CAT R]SULT IN REVO-
c;,?ro:,1 oF iurs pi:lil1Ii, crT,iIro:i uND:R PRoVTSTO:iS Oi Ln\E aJU::iY',.l INFRACTTON OFDi:;.i\Cii, irr-D,/OR OTIiER
REiiEDIES ALLOI^JED BY LAI''.
!iHiI.: RE.\D\' 'CR
i:iST''C?1ON, C.\:: 6gJ-;065. ]', }1I\I:IU:': OF .]T L:.'\ST 2{ IIOURS ADV.,l'::CE NOTICE FOR 'INSPEC-
lrulliEtrr-==-:-li:.-- l, ,rIVL:i:-]:L-Lhe f ollokiit in:criation ready: Fcrmit number, job address, type
of insptccron, when it wrll be ready, your iame and phcie aun.er, and 3i]'special Circctions to site-
BUILDI:.iG DIVISION: .
F.'QUIS,:D I:]SPECTiCNS :r-
r
Foundatiotr lnspectroni To be made after trenches are etcavated and forms erected and when all
natertals !or tne rounoati-on are ciclivercd on the lob. iahcre colcretc from a certral nixing
plant (comonly termed "transit mrxed") IS to be used, naterials need not be on the job.
Concrete SLab or Under-:loor InsDection: To be maie afr-er al1 j.n-slab or under-floor building
aeni:e equiFmot,cmuLt, piplirq a(rcssorres, and otrer ancil-lar!'equipment items a!e in
place but-beiore any concretL is poured or floor sheathing lnstaIleC, rncluding the subfloor.
Framino & Insulation InsDections: To be made after the roof, aI1 iraming, fire bl-ocking, and
ffi arry :-1re Ji(rer-I pioes, f ireplaces, c:rimne!'s, and ve:ts are complete and alI rough
electrical and plumbing are approved. A11 waIl rnsulation and vapor barrier are in p.Lace.
La!h and/or Gvosum Board InSpectlon: To be made aI-ter aI1 Lathing and qypsun board. lnterior
jro'es-rcr:orilT--Ln-t)lace E-u*- bu-re any piasEerinq rs applied and be:ore gypsw board joints
and fasteners are Laped and finished.
Fi.nal Inspection: To be nade after the building is comPlete and before occupancy.
AppRovAL REQUIRED. ]lo work shall be <ione on any parL of'.he building or structure beyond the Point
indicated in each successive lispecti.on without first obtsj-nlng lhe aPProval of tie bu.i.ldinq offlcial.-uan appror.t shaII be given cnly after an inspectj.on shall have been maie of each successive step
in the ionstruction as incicated by each of the inspecticns requirec'
NoTE: AIl building pernits require inspectj.ons for the Hork authorized, such as but not limited to:
A. Block \,ta1l-: TO be mace after reinforcing j.s in place, but before 3ny grout is poured- This
fffi.il* is required f or each bond beam pour. There will be no approval until the PLumbinq
an.i electrical inspections have been made and approved'
B. l,tood stove: To be made after completior of masonr!' (if applicable) and uhen installation is
*efat* InsLaLlation shall be in accordance with an approved, natj"onally recognized testing
agency and the nanufacturer's j.nstallation instructj.ols.
C. UobiLe Bome: An inspection is required after the mobile home is connected to an approved
EEiE-rci--eptic systlm f or setbacli requirements , blocking, f ooting conDec tion, tiedowns ,
skirting, and plubing connections.
Footings and piers io comPl-y wlth State foundation requirenents for mobile homes or as
recomended by the manufactuler.
Mobile homerminimum finj-sh floor elevation shall be certified when required by a flood-
plain management letter.
ijobile home tiedowns, when required, and skirting shall, be installed and ready fcr inspec-
tj.on ilirhin at leas! 30 days ifter occupancy. Tie.loHis and skirtrng shal'I be installed
Per enclosure.
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2
2.
3.
D.Above grade
nppROVED PL\:JS itUST BE ON TIIE JOB SITE AT ALL TIMES DURfr-G WORKING HOURS. THIS PERMIT WILL EXPIRE
IF WORR DOES NOT BEG]N I"IITHIN IBO DAYS, OR IF I,^]ORK IS SUSPENDED OR ABANDONED FOR }IORE THAN 180 DAYS.
SUSPENSION OR IIEVOCATION i,1AY OCCUR IF TII1S PEfuYIT WAS ISSUDD ON THE BASIS OF INCOMPLETE OR ERRONEOUS
INFORM}TION.
ANYONE PROCEEDING Pi-rST TilE POIIiT Or REQUIRED TNSPECTIO:IS HILL DO SO AT TIIEIR OwN nISK.
SUtsSURFACE ]IND ALTERNA?IVE SEi{AGE DlSPOSAL SYSTEHS:
I. Permits shall be effectrve for one year fron the date of issuance.
2. Upon completing the construction for which a permit has been rssued, the permit holder sha1l
nbtify t-he Lane County Department of Planning and Comunit), Development by submitting the
installation record form. The Department shalI inspect' the construction to detcrmine if it
complies with the rules contained in this Civision. If the constructlon does comply with such
rules, the Department sitall issue a certlficate of salisfactory conpletion to.the permiti holder-
If.the.consttuctiff dobs not comply with such ruIes, the'Department shaLl notlfy'thd petnit
holder and shaIl require satlsfactory completion before issulnq the ccrtificate- Failure to
neet lheJsguirements for satr5factory completron L'ithin a reasonable- ti.ne constitutes a vio-'
l3:ron of ORS 154.605 to 154.145 and this rule.
SeLbrcks _ Subsurfacc seraqe Dlsposal
l
I ron: I tterror proPerti' 1 rncs
Ed.le o: road r1-ii)t-of-waY
RurLciinq ioun.lat:on
iieILs, other uatcr sources
scpti.c Tank Dra i nf ield
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10 '
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100 |
10'
10'
50'
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Permit No.,346<t Twnshp.
MUST BE IN BLACK lNK torm c55-11
Range e4.t3 Tax tot i@C
Standard System tr Alternative tr Tvpe)
Job Location (Street Address)
Supdivision/Partition #Lot Block
-
DETAIL SYSTEM PLOIT PLAN AS CONSTRUCTED6
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^l),1i.-^"Gr-,'rfi1"'9VICINITY MAP
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FOR INSTALLER'S USE: Trench Dept:HSLBICI
lNK oN
Tank Capacity Manufacturer
Measured Distance from Well to Tank 4 From Drainfield
LY
Gravel Depth Below Tile ;,,
,<DT
Total Length of Lines l<I
/ol'<-./a/COMPLETE THE FOLLOWING IF A PU P WAS USED ON THIS I LLATION
r(installer's name'certify that a (Mfg.)(Model No.)Pump
and Mercu (M have been installed with this sewage installation
Signature Date-
FOR SANITARIAN'S ONLY:System Approved tr System Disapproved E Needs Correction
COMMENTS:
4 bn
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d/^Date
DateSystem Capacity 4rz gal./day Signature
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETTON When sig
dence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal
T
To request inspection, return all three (3) copies of this form to: Lane County Environmental Health Services, located in thedasem€rit of the
Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401.
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the County Sanitarian, this cenificate is evi-
at the above location.
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125
R ASS'S
Please complete all lines inside white boxes, if possible.Extstlng Bulldings or
lmprovements on
Property
F House
Elf Barn
El Garage
E Mobile. Home
E Shed
SEPTIC INSTALLEDEI Yes
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OWNEB OF PBOPERTY (iI nol sma ra aboy.)PHONE
OWNEBS ADORESS (il not rEmc s3 lboyc)ztPt-t t-lo-tsaN
Iiacre rf Dlrections to slte
from Courthousethrtte -Tto{
dt I ct N -Z foS'
/rlc\/*,4 0(,t,
Town3hip Rane. Scction 1/4 S.ction fax Lot
rownsnrp Hangc Scctton l/4 Seclion Tax Lot
SITE AD
ztP
MAIL PERMIT TO:For Mobtle Home
Placement OnlyL- G--Brand
/" rJ^-Year
Size
..-)l €7 No. of Tip-outs
-
No. of BedrmsztP
License #-
io
Land Management Div. staff can
not be held responsible for
evaluatlons or recommendations
based on false, tnaccurate or
lncompleto Informatlon
,+
NUMBER
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AFFLTcANI $urLEy, EDTTARhANE
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