HomeMy WebLinkAboutPermit Septic Tank 1997-11-14zZ,Z h,c n
PERMIT #
MINOR SEPTIC REPAIR PERMITREOUEST
FOR:
EXISTING SINGLE FAMILY DI'IELLTNG AND GARAGE
19TH AND YOLANDA AVE., LEFT AT INTERSECTION
#3
L@ATIor.I AOORESS
STFWTURES Nffi N PROPERTY
r.lo. oF sToRrEs
PPLICA},IT NAATE A AODRESS
COaJTRACTOR i INSTALLEP SUILDER NA^4E c@r
OWNER
4
PROPOSED IJSE SEfrP NSTALEO
lOa.l
PHONE
t7 03
SPRTNGFTELD, OREGON 97 477L829 YOLANDA AVE.,
NO. OF EATPLOYEES @f*STRI.,CIO.I COSTAr'ALI'E
SAME AS THE JOB ADDRESS ABOVE "*'74 6-L263
SAME
waTER NST t"1!O
RAINBOW
MINOR SEPTIC REPAIR PERMIT
SAME AS THE ABOVE
INE BOSTOCK
I have carelully read BOTH sides ol this
MAXINE BOSTOCK
ication and hereby certify that all information is true and correct
DAIEPRINT NA}.'E
READ CAREFULLY! Your Authorization ls Based On The Following Conditions
APPBOVED BY DATEFEES DUE: 9
aALL FOR INSPECTIONS (SEE BACK OF FORM FOR INSTRUCTTONS) 687-4065
SEPTTC permlts are good for one year. ALL other permits expire after 180 days unless lnspections ate current.
LMD 040 Rev. 6/92
PHONEOru.lERS MllEt ADORESS
AT THE JOB ADDRESS ABOVE
- VIOLATIONS V
STTBACXS AND OTTIER, CONDMONS OF APPROVAL MUST BE STRICILY OBSERVED. VIOI.ATION CAN RESI'LT IN RBVOCATION OF THIS PERMIT.
CITATIoNS MAY BB ISSI ED T NDBR THB PRoVISIoNS OF LANB COLTNTY'S INFRACTION ORDINANCB AllDrlOR OTIIB. REMEDIBS AILOWBD BY LAW.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTTCE MUST BE GrVEN FOR TNSPECTTON REQUESTS
IIave the following information ready when you call: 6874M5
Pe.rmit number - Job ad&ess - Type of inspection required - When it will be ready
Your name and phone number - Any special directioru to the site
powERroENrERrJ'poNLAND. "*""i#,:lr""i,TH11$'3Flll#ffirit:3##yiffi'rffi[BffiffIi*'*?--r *oF*ErRF,NcrroNs,MAy
ENTER I,JPON ANY LAND AND MAXE EXAMINATIONS
'},ID
SURVEYS AND PLAG AND MAINTAIN THE NFEESSARY MONT'MENTI| AND MARKERS THERTON.
REQI.IIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
LJNDERGROLIND PIPING INSPECTION: To be made after all undergroundpiping has been irutalled, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-floor building service equipment conduit, piping
accessories and other ancillary equipment items are in place but before any concrete 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, prior 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, plumbing, and mechanical inspections have been made and approved.
INSULATION INSPECTION: To be made after aU insularion and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM 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 ard fasteners are t@ed 6rd finished.
ADDITIONAL INSPECTIONS MAY BE REQIIIRED, such as bur nor limited to;
BLOCK WALL: To be made after reinforcing is h place, but before any grout is powed. The inspection is required for each bond beam pour. There
will be no approval until the plumbing and electrical inspections have been made and app,roved.
FINAL MECHANICAL INSPECTION: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipment.
FINAL PLUMBING INSPECTION: To be made just prior to the building, strucure or remodeled area being occupied.
FINAL BUILDING INSPECTION: To be made after finish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILEMANUFACIURED HOMES: An inspection is required after ttre mobile home is connected to an approved sewer or septic
system, Prior to covering sewer or water lines, for setback requirements, blocking, tiedowns and plumbing connections.
Footings and piers to comply with State foundation requirernents for mobile homes or as recofllmended by the manufacturer.
Minimum finished floor elevation shall be certified when required by Floodplain Management
Tiedowns, if required, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per enclosure.
APPROYAL 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 orily after an inspection shall have been made of each successive step in the construction
as hdicated by each of the irspections required.
rHIs ,ERMIT wrLL
',*IRE " *,t5%1t""1?Hi[Yi^]i,il?T#,iTfi 3il]tli.?ffi'?HlTFlr"ffifiJi"ffi M.RE rr{AN ,80 DAys.
SUSPENSION OR REVOCATION MAY OCCI,JR IF TI{IS PERMIT WAS BSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST THE POINT OF REQTIIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
Your signature on the front of this form verifies the following: I HAVE CAREFULLY EXAMINED TI{IS 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. Ifu1tfer celify ttral any and all work performed shall be done in accordance with the Ordinances of L- iounty and the laws of the State of degon per-
taining !o the work described herein. I further certi$ that if I am not the owner of the property, my regisuation with the Builders Board is in full forceand.effect as required by ORS 701'055, and Orat if eiempt the basis for the exemption is not a trereon]and that only subcontractors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURFACE & ALTERNATIYE SEWAGE DISPOSAL SYSTEMS:
When subsurface construction is,complete, the permit holder shall notify the County Land Management Division by submitting the installation record
form. .11 irspection will be made by a qualified sanitarian. If construction compliis with all rutEs a certificate of completior, iill b" issued to the permitholder. If construction does not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of compietionwill be issued. Failure to meet satisfactory completion within the alloned time constitutes a violation of ORS 454.605 to 454.745 and this rule.
SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK DRAINF'IELDFrom: Interior property lines l0' 10'
Edge ofroadrighr-of-way 10' 10'
Building foundation 5' 10'
Wells or other water sources 50' 100'
SXTTCH rle inirxlihrl
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TC, IE COMPLETED 8Y INSTALLER: .zI C./
PIRMIT ISSU[D.-TO: , ]ostollcr'r no*c =24( , Z'1''Y =1--,;;:J:;j&;*-: - 4eg-- luirairspcmiij,,u-be,-
-{47e - qr
::::':::::'#:-1 fffui ;:::'I' ;:;''4'*'/'- *'!1
Wotcr supply by: Publk tftcm -d lndivUuol ty!t?fr---- Coarnrunity tyrtcm ----
5cptic lonl: Dirloncr frcm rcll Ec.l. Mote.iol ?Nc - No. of comporlments -l.lTotol l(uid corrl<.itt-/&-a-- - 9ol. lnridc lengtt. ?a.z/ 'llllaridc vidth --:;;Z-aa- -:1f'
Tilc dislrrol licld: Dirtribution
Lcngllr coch hnc
Totol lcogtlt
Width ol trench
Totol sqrorc fmloEe
Di:toace bctwea lioc:
fvpe ol lilter motcriol: Grorcl
fr. Distoncc lrom
l.O- -.lcet
f illcr moicriol bcneoth rile. / irtics.
Degth of filtsr motcriol ovel inchas.
oor.-/-. ./-z /
bor? Ycr i! No D
--214t.n 6-l
_-J__
Othcr
ft Well
h. Ncorcrl
[cct
I Side.( Reor qt -- /t' J*t
Signollrc :2.-(*/
IOi USI OT SANITARIAN ONLY:
Sy:ten opporcntly vill ft rill not fl lunctioa sotisfoctorily, oil ir thcrefo:c opprovcd {or occuponcy '{6rxlgptowd a
le mo*r:
LAI{[ COUNT/ Xt^tffi DttallMtHf
--z7l-t - - '---
Dotc i'- .-)i -c,c
&rh r..6.r'.frik! - -qtr- ]I€o.:' tor .t,*
?.i-i+ (r'.,'@-t-,i,fial
AP9I.ICATIOT{ FON BUEISING MRfiUT *
tcr$s Cane!*y, G*grn
No. 2 018 '4(
ri '1'&*'
It.i{rtt To tNDtcaTI NolTNtllt otrtcrloN
&-, nES
Please complete all lines lnslde white boxes, tf possible E.&thtg 8rilr&lgc q h*
Frclernenls qr tlp Propgrt-/y' Hour"
-
Bamr'' on^g"
-
Mobile Home
-
Shed
SEPTIC INSTALLED?F yes
-NoWater District
P A,u ao'rJ
"')Y'zo Y t "no Av- ,
72r'/2
Owner ol Parcel (il not same as Phone
Omer Address (it not same as above)
CCB License #tnstailer / tsuiloer / uonlraoor
-2
J
zip
zip
Pnone
o
,E
sA rl e- As
Dlrcetlons to sfte trom
nearest maln lntenectlon
lrVrrRs
E
+
trf ATfiat L
c-rroN
NAP, PARCEL NUNBER
(Fol'd m tu rnrp.ln thr A.r.rrnrm t f.r.tbn D.Pf,
JJ_ fi_e/,!tfornrHp fune. Sralm t/a S.cdm
torn.fiD- ffi- EAdon -iZ-sfrsr
TAffit Enge -5aion- -iZEAm-
307
Ter Lot
f.r Lot
f.r Lot
LASG
Sffe Address
NL
A
?
EE
Mail Permit 7ot
)lrm
For Moblle llome
Plaement Only
starts with X)
x-
No. ol Bedrms
Ucense# (No.
Year
Size
Dlstance
Home
Usc
T7FISYerlfiled ,'Parlltlon I
Comments
lnlormallon Fcquest Only E
STAFF INITIAUI
LllD staft can ilOT be held
responslble for evaluatlons or
recommendatlont based on
false, lnaccurate or lncom-
plete lntormatlon.
LCPW 140
c a l
fort
W: 3 -'NE COUNTY DEPT ENV MGT RE/ -PT # 3L7297 DATE L]-]-497
APPLICANT BOSTOCK, MAX1 ADDR L829 YOLAN-.r AVE., SPRINGFfELD, ORE
TL# 1_703243400309 SUBDTV LOT BLK
NEW BLDG TYPE USE R BDRMS O UNITS OO]- STORIES #AT,OES OO1 PHONE 746 L263
owNER NME BOSTOCK, l4AXrNE ADDR L829 YOLANDA AVE., SPRTNGFTELD, ORE
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAYS
BP
BP
BP
BP
BP
PL
MECH
SUR
PCK
SDS
SDEQ
ADM
TECH
#FIXIBATH:
LC 317297 SDSR
FEE SDSR
FEE
FEE
SWR: FT. WTR:
MECHANICAL FEE
STATE SURCHARGE
PLAN CHECK FEE
FT. RAIN:FT
59"
252
CATG: PLN
SEQU:
TAKEN BY RLH
RA sDs
1
EST.
ELE PCK
COMPLETION DATE
SI OTR
DEPOSIT **
t-00. 00
30. 00
15. 00
5. O0
t_50. 00 cK
ISS
2 9
. ?Fr.nlvsg:
DE3 {5tffi
SEWAGE DISPOSAL SYSTEM ''AS BUILT'' PLAN
inspeaim md a:fnriz* trc systm to Ue OeaOlbd sadi6r. R€i, and rep(an@ ol thb co.npbtsd rorm by tlp O.pstncrt (tr Ag€nr) establishas tho offidal rptica datg of yff
roSJ€sd ,or tho pro€rror irsp€d,orl Ploaso comol€to all trw sodions o( th6 ftrm and ratun lo Lans Colmtv Emionmfftal Health. 125 E- 8th Ave.. Emem- Oreoon 97'|o1-
SECTION 1: BASIC INFORMATION frqpr,-t'c
Permit #3ltz -?7
To Be Completed By lnstaller:
PERMIT ISSUED TO:
Map/Tax Lot #t7-o3 1t.3{ rL 3 01
(Date received)
8"4Name:Address:
Property Address:Sa,r-.e q.5 rrt.l e
TOTAL #: Bedrooms- Living Units
-
Basement Yes- No
-WATER SUPPLY: Public o lndividual o Community o Other (Name)
SEGTION 2: Materiats List (ldentify and list all materials used in systeml:
SEPTIC TANK: o Concrete o Poly r: Metal
Manufacturer Total Liquid Capacity-gal.
Distance from Dwelling ft.; ' Effluent sewer ASTM #_' ; Distance from well_ft.
DRAINFIELD:
Drainfield Pipe (ASTM#)
-;
Header Pipe (ASTlul#)-Total Linear
Depth Rock Beneath Drain Line
Switch (Mfg. and No.
(Complete as Applicable): Working CaPacitY
; Depth Rock Over Drain Line-in.
certify that a
ump and Mercury Float
been installed with this sewage installation.
of Chamber gal. Gallons per Cycle gal-
Distance of \A/ELL from Closest Portion of DRAINFIELD
Mfg./Type/Sze ot Rock Filter Mate
PUMP SYSTEM:
I (installefs name), '
(Mrg.)odel No.
"Working Capacity"remaining after alarm -has activated gal.
S
OTHER: (Materials not listed
FOR SANITARIAN'S USE ONLY:Approved o System Disapproved . o Needs Correction
-/. ,re-A
o System Corrected; Date:
INSTALLANON RECORD & CERTIFICATE OF SATISFACTORY COMPLmON. When signed by the County
sanage disposal system at the above location'
Capacity gaVdaY
49.665 of satisfactory completion of a subsurface
(over)
/z ./s
certificate is evidence as Per ORS
.,eit I r
t
"-- Permit #3t7z-97
SECTION 3:
AS-BUILT PLAN OF THE CONSTRUCTED SYSTEM. Show the follorirring: North anow, septic system
referenced to a fixed Point, such as,
within 200 ft., drive orwalk-ways, all
slopes). lnclude final grade shots of
building foundation or property @mer, property lines, wells and water lines
buildings, property dimensions, streams, ponds, cuts, escarpments (>50%
ends of trenches, distribution box, and septic tank outlet elevation.
H 0"5 g
t
I
J
\
,I
I ,$,)
be,
d,uFnr"t fr'ovs.e,.
>5 n- JL fe />'ta fro.f,'eotJ t?Ol 2
F,q
4l0r)AN l* t€E I i ves,
I certify the informdtion provided in this notice is
conect, 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 (Please .nfiz<
([itle as shown on DEQ license)
Telephone
License
Bonding
ft r,1
t
I
/fY*\ ft', ::, l, *-i ,.:' . .,,,.i , . : r,.F t fi :| N,I!., i
/3oX ADou +
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VICINITY MAP
******************************************
and found it to
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5qr 68 6 tt
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