HomeMy WebLinkAboutPermit Septic Tank 1991-02-207/10 €o
PERMIT #55r-71
REOUEST
FOR:
./4a-
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READ CAREFULLYI Your Authortzatton ts Based On The Fo[owl Condltlons
FEES DUE: S APPROVED BY:DATE
7-4year.
LCA FOBL SPEtN,c TIONs (sEE CKBA OF FORM INSTBUC 68 065TtoNs)PTICSE arepermlts tor onegood LAL other 'spermlt atter 801explre da unlessys areinspactlons cuilent.
VIOLATIONS
SBTBACKS AND OTHBN. C!)NDrIIONS OF APPR.OVAL MUST BB STRICTLY OBSBVED. VI()LATION CA}I RBIIULT IN RtsVOCATION OF THIS PERMIT.
CITATIONS MAY BB IIiSI,JBD I'NDBR. T1IB PROVISIONS OF LANB COUNTY'S INFN'ACTION ORDTNANCB ANDloR. OTHER RBME)IES ALLOWED BY LAW,
AMINIMUMOF ATLEAST24 HOURS ADVAI{CENOTICE MUSTBEGIVENFORINSPECTIONREQUESTS
Have the following information ready when you call: 6814065
Perrnitnumber - Job address - Type of inspection required - When it will be ready
Your name and phone ntunber - Any special directions to the site
,.*BRT.ENTERUFoNLAND. **".ffi,ll%i,XBi#3Fl{Tffift:i#efffi"rHTH?f#ffi*"r ooprHBrRFuNcrIoNs,MAy
BNTER T'FON ANY LA}ID AND MAI(B EXAMINATIONS A}'ID SI]RVEYS AND PLACts AND MAINTAIN TflB NBCSSSARY MONT'MEI{TS TNO UTNreNS TTMSON' -
REQI.IIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and rry required reinforcing steel is in place.
LINDERGROLJND pIpING INSPECTION: To be made after all underground piprng has been irutalled, pnor to any baclfill.
coNcRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-floor building service equiprnent' conduit' piping
accessories and other ancillary equipment items are in place but before any concaete is placed or floor sheathing installe4 including the subfloor'
ROUGH MECHANICAL nr-SpscTloN: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING nCSPBCTION: To be made after all plumbing rough-in is in place, prior to being covered
FRAMING INSpECTION: To be made after the all framini, nreurocmn!, bracing and roof are in place ard all pipes' chimneys and vents re complete
and the rough electrical, plumbing, and mechanical inspections have been made and approved'
INSULATI-ON INSPECTION, to U. *"a" efter all insulation and vapor bariers are in place, Prior to'covering
LATH AND/OR GypSUM BOARD INSPECTION: To be made after au lathing and gypsum board, interior and exterior' is in place brut before any
plastering is applied or before gypsum board joints 1d fasteners are taped srd finished'
iOolffbNei nSffCff6Ns MAY BE REQIIIRED, zuch as but not limited to;
BL6CK ryALL: To be made after reinforcing is in place, but before any grout is poured. The inspection is requted for each bond beam pour' There
will be no approval until the plumbing and electricat inspections have been made and approved'
FINAL MECHANICAL INSPECTToN: To be made just prior to the struchJre or r*tod"l"d .r.a being occupied urd pior o opcrating any equipmenr
FINAL PLUMBING INSpECTION: To be made jusiprio' to the building, stnrculre or remodeled rea being occupied.
FINAL BIIILDING INSPECTION: To be made urt"r'rrnirt gading ana ile uulaing, stnrcture q renro&led area is completed md ready for occupancy'
MoBILE/I,IANUFACTURED HoMES: An inspection is req,rirea-arur the mobile home is corurected to ur rypT oved sewer or septic
system, prior to covering sewer or water lines, for setback requiremens, btocking, tiedowns and plumbing connections
Footings urd pien to comply with State foundation-requirements for mobile homes or as recommended by the mrrufacn[er'
Minimum finished floor eievation shall be certified when required by Floodplain Management
Tiedowns, if,required, shall be installed *a r"ray for inspeii.,n *itirin:o iays after occupmcy. Tiedowns shall be installod per enclosure'
APPROVAL REQIiIRED
No work shall be done on any part of the building or structrue bey<nd tlre point indicated in each successive inspection wi0rout first obtaining the
approval of the building "mJia.
such approval ir,"ir u" gii""iirv;ru. * inspection strall have been made of each s,ccessive step in the construction
as indicated by each of the inspections required'
APPRoVEDPI.AI.ISMUSTBEoNTIIEIoBSITEATAIITIMESDIJRINGWoRKINGHotJRS.
THIS PERMIT WIII. E)(PIRE IF WORK DOFS NOT BEGIN WTIHIN I8O DAYS' OR T WONT TS STOPPED OR ABANDONBD FOR MORE TITAN I8O DAYS'
SUSPENSION ON NNV.ir"Cirib-IiiEiOCCUN N_TtIIs PERMIT VrAS TSSUSD ON THE BASIS OF INCOMPLETE OR ERRONEOUS INTORMATION'
ANYONE PROCEEDTNGPAST TtrEporNT oFREQT.IIREDTNSPECTTONS WILLDO SO AT THEIR OWN RrSK'
your signa*re on rhe front of this form verifies the following: I HAvj CAREFULLY EXAMINED Tms CoMPLETED APPUCATIoN' and do
hereby certify that all information hereon is *" *J*rr"r,"-and that I hav" " [gd i;-;t in the pro'perty ss owner of record or authorized agent' I
further certify rhat any and all work perform"d ,hdl ;;;;; in accordance *itrrirr" orai""rr"o of L*" io*'ty and the laws of the state of oregon per-
taining to the work descriiJ'r,rr"i'I it nt", cotiijrhul*_L"r1,.t u" or""Jr oll";;;rry';y *gisuation wior theBuilders Board is in tull force
and effect as required by'o[s ioi.oss, and that tf ;i*rpG b;is for $re "*"-ptiorl rrot a trob", ed that only subcontractors and employees who
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i" *^pu*ie wittr bRs 701.005 will be used on the job'
SUBSURFACE&ALTERNATWESEWAGEDISPoSALSYSTEMS:
when subsurface constnrction is complete, or" per*irholder shall notify ttre county Land Manragement Division by submining the installation record
form. An inspection will be made by 1qu$ifie4 ,*i*i*. If construction "o-puL *iq 4I rul-es a.certificate of completion will be issued to the permit
holder. If construcrion doqs not compry *io -r"r, i." p"iiir,ora"r *ur u. ioii["+ *a all corrections shall be made before a certilicate of completion
will be issued. Failure to me€t satisfacto,ry compl"ti.;;ithi" the allotted time dn"titotes a violation of oRs 454'605 to 454'745 and this rule'
SUBSURF'ACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK
From: hterior ProPertY lines 10'
Edge of road right-of-waY 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
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Permit No.s{r-MUST BE IN BLACK INK
Twnshp. /a Range z Section Tax Lot
Standard SYstem Alternative mE
Job Location (Street Address)
Parcel BlockSupdivision/Partition #
DETAIL SYSTEITI PLOT PLAN AS CONSTRUCTED
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VICINITY MAP
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USE BLACK INK ONLY
Gravel Depth Below Tile .A
FOR INSTALLER'S USE: Trench DePth
Tank CapacitY - Manufacturer -
Measured Diitance from Well to Tank - From Drainfield -- Total Length of Lines Z-7O'
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
l(installer'sname)certifythata(Mfg.)-(ModelNo.)-Pump
"nd
M"r.ury Floai Switch (Mfg. and No.)- have been installed with this sewage installation.
Signature Date
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FOR SANITARIAN'S pNLY:
System CaPacitY fJo gal./day Signature
Approved. tr Di p tr Need
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5dF oAR 34'C Date -,
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INSTALLATION RECORD & CERTIFICATE
dence as per ORS 454.665 ol satisfactory
OF SATISFACTORY COM PLETION
completion of a subsurface sewage
the County Sanitarian, this cerlilicate is evi-
disposal system at the above location
When
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To request inspection, return all three (3) copies of this form to: Lane county Envi
Public Service Building, 125 E. 8th Avenue, Eugene, OR 97401'
ronmental Health Services, located in the basement of the
fr,3,y'form cu-ra7
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Exlstlng Bulldlngs or
lmprovements on
Property ,<'ff Hor""
El Barn
EI Garage
El lrlobile. Home
E Shed
SEPTIC INSTALLEDE Yes
El No
Water District
Rn i.' I*.il
Please complete all lines inside white boxes, if possible.
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MAP, PARCEL NUMBER
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Townrhip nlngc Scction 1/[ S.ction Tlr Lot
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Dlrections to site
from Courthouse
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PERMIT TO:
Brand
Year
Size
For Moblle Home
Placement Only
No. ol 1ip-outs
-
No. ol Bedrms
License #-
Land Management Div. staff can
not be held responsible for
evaluatlons or recommendations
based on false, Inaccurate or
lncompleto lnformatlon
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