HomeMy WebLinkAboutPermit Septic Tank 1993-01-29OGB I <?trLD c"
q-frPERMIT #
REQUEST
FOR:
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I have carefuily read BOTH sldes of thls appllcatlon and hereby certlfy that ell
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lnformatlon ls trug and correct
READ CAREFULLYT Your Authorlzatlon ls Based On The Fo!Condltlons
/-z 7-7)APPROVED BY:DATEFEES DUE: $
CALL FOR TNSPECTTONS (SEE BACK OF FOBM FOR
SEPTIC permlts are good for one year. ALL other permlts expire after 180 days unless inspectlons ate current,
687-4065
VIOLATIONS
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A MTNTMUM oF AT LEAsr 24 HouRs AD'ANCE NorIcE MUsr BE GrvEN FoR INsPEcTIoN REQrlEsrs
Have the following information ready when you calL 6874065
Permit number - Job ad&ess - Type of inspection reqtiied - When it will be rdady
Your nalne and phone number - Any special directioru to the site
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REQI.IIRED INSPECTIONS
FOTINDATION INSPECTION: To be ma<ie after excavationi for iootings are complete and any required reinforcing steel is in place.
LJNDERGROTIND PIPING INSPECTION: To belnade after all underground piping has been tulstaUed, prior to any backfill.
CONCRETE SLAB OR LINDER-FLOOR INSPECTION To be made after all in-slab or under-floor building sen ice 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 afterall 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 arid vents are complete
and the rough electric4l, plumbing, and mechanical inspections have been made and approved.
INSULATION INSPECTION: To be made after all insulation and vapor barriers ar.e in plpce, 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
plasterirg is applied or.before gypsum board joints and fasteriers are tryed -a n"irfr"a.
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ADDITIONAL INSPECTIONS MAY BE REeLIIRED, zuch as
'but not limite.d to;
BLOCK WALL: To be made after reinforcing is in place, but before any gout is poured. The inspection is required for each bond beam po*. ifro"
will be no approval until the plumbing and electrical inspections have been made and approved.
FINAL MECHANICAL INSPECTION: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipmenl
FINAL PLUMBING INSPECTION: To be made just prior to the building, struchre or remodeled area being occupied.
FINAL BITILDING INSPECTION: To be made after finish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILEA'IANUFACTURED HOMES: An inspection is required after the mobile home is connected to an qproved sewer or septic
systemr prior to covering sewer or water lines, for setback requirernents, blocking, tiedowns and plumbing cormections.
Footings and piers to comply with State formdation requirements for mobile homes or as recornmended by the manufacturer.
Minimum finished floor elevation shall be certified when required by Floodplain Management
Tiedowru, if required, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be insrrlled per enclosure.
APPROYAL REQTIIRED
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 only after an inspection shall have been made of each successive step in the construction
as indicated by each of 0re irupections required.
APPROVED P["A'NS MUST BE ON THE JOB SITE AT ALL TMES DURING WORKING HOIJRS.
TI{IS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WTHIN I8O DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF THIS PERMIT WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDTNG PAST THE POINT OF REQLIIRED TNSPECTTONS WILL DO SO AT THEIR OWN RISK.
Your signature on the front of this form verifies the following: I HAVE CAREFULLY EXAMINED THIS 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. I
further certify thal any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of degon per-
taining to the work described herein. I further certify that if I am not the owner of the property, my registation with the Builders Board is in full forie
and.effect as required U1 QnS 701.055, and that if exempt the basis for the exemption is noted hereon, and that only subcontractors and employees who
are in compliance with ORS 701.005 will be used on the job. :
:'lSUBSURFACE & ALTERNATIVE SEWAGE DISPOSAL SYSTEMS:
When subsurface construction is complete, the permit holder shall notify the County Land Management Division by slbmining the instdltatien record
form. {1 irspection will be made by a qualified sanitarian. If constmction complies with all rules a certificate of iompletiotr iitt U" issula io t}re permit
holder. If construction does not comply with rules, the permit holder will be notified, and all correcrions shall be made before a cenificate of compietionwill be issued. Failure to meet satisfactory completion within the alloned time constirutes a violarion of ORS 454.605 to 454.745 anil this rule.
SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK DRAINtrIELDFrom: Interior property lines l0' 10'
Edge ofroad right-of-way l0' l0'
Building foundation 5' 10,
Wells or other water sources 50' 100'
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Permit No.?c!-q3 Range o section aL\'q3 Tax Lor o1)\s
Standard System X Alternative
Job Location (Street Address)
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Supdivision/Partition #Parcel Lot _ Block
DETAIL SYSTEM PLAN AS CONSTRUCTED
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VICINITY MAP
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o!r USE BLACK INK ONLY
Gravel Depth Below Tile L,,FOR INSTALLER'S USE Trench Depth ?.1 ',
Tank Capacity \Poo qq\Manufacturer i. \\ c'.* e
Measured Distance fromVrll to Tank From Drainfield - 'Ibtal Length of Lines
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION
I (installer's name)
and Mercury Float
certify thar a (Mfg.)(Model No.)
Switch (Mfo. and No.)have been installed with this sewage installation
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t"tl^Pump
Signature Date
FOR SANITAFIIAN'S USE ONLY: 6system Approved n System Disapproved tr Needs Correction
COMMENTS
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Corrected Date
DateSystem Capacity gal./day Signature
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETTON When ned by the County Sanitarian, this certificate is evi-
system at the above locatton.dence as per ORS 454.665 of satisfactory completion of a subsurface sewage disposal
To request inspection, return all three (3) copies of this form to: Lane County Environmental Health Services, located in the basement of thePublic Service Building, 125 E. 8th Avenue, Eugene, OR 97401.
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ii-ils llAP is FOR 'ilir Puilptls: oF
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D NO S<,ALE
NOT E sEE cHECKLrir oN REVERSE slDE
Approved as a ninor subdivision
by tire Lai:: County Land Development
Revielv Cor;i:';: i iiee
LEE I,iiLLER,
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MINOR SUBDIVISION
IAx LOT(S) za
SSESSORS MAP 1-1 - 6 4-
SECTION 5 L tlt lcz 1C-tT J*!r F r
TOWNSHIP ll S, nIUCE i'.,r j l-:
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GU\NER .8 BF\lfTCt{
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KF--T!! AilTOWNER
ADOR ESS
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Bnanch Engfneenfng
November 4, l-993
31O Nonth Sth Stneet
Spningfield, Onegon 97 477
[5O3] 746-0e,37
FAX [5O3] 746-OsBsWalter Ford
558 South- 57th Street # 12Springfield, Oregon 97478
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DearMr. Ford: .1-\1 g N, 'LctA
Branch Engineering and city of Springfield Engineering personnel
recently conducted an inspection on your project 20th Street,
Springfield Project No. 3-a26. The following items remain to be
completed:
1. fnstall 3 type I delineators,
2. Crack seal joint between o1d and new asphalt paving.
3. Remove AC chunks.
4. Grind down concrete in gutter at weep hole patch.
5. Fix asphalt paving match line near North driveway.
6. InstaII driveway approaches at curb cuts, 5' of concrete
and 4' asphalt paving.
7. Bring up asphalt paving where Iow, in front of driveway.
The enclosed notices show that Gary Martin Concrete and. Asphalt is
no longer insured or licensed to do this work. The city has
indicated that the Final Occupancy Permit for the dwelling will be
held until the above itens are complete.
Please give me a caII to discuss how you wish to proceed on this
proj ect.
Thank your
-/?eY, P'E
attachments:Notice of insurance cancellation
Statenent of license suspension
cc:Ron Sather, Cfrief of Construction
TFANSPOFTATION CIVIL SUtrVEYING
NOTICE OF CANCELLATION OR NONRENEWAL OF POLICY
NONRENEWAL OF POLICY
TO THE FOLLOWING NAMED ADDRESSEE:
'issued to named insured N
is terminated. Termination shall be effective at 12 :01A.r.4
ADDRESSEE -
sL 85t8242A
CITY OF SPR]NGFIELD
225 N 5TH
SPRINGFIELD, OR 97477
ADDRESSEE.r
lt6 \
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CANCELLATION OF POLICY FOR NONPAYMENT OF PREMIUM
virtue of this notice. vour interest in Policv Number
CONICRETE E RSPNRIT
SL 85 L8242A
SL 85L8242A
OREGON CONISTRUCTIOI{ CONITRACTORIS BOARD
STATE OF OREGON
700 SUMMER ST., NE, SUITE 100
SALEM, 0R 97310
STANDARD TINIE ,1
lf premium has been paid, premium adiustment will be made
as soon as practicat after cancellation becomes etfective, or
upon demand. lf premium has not been paid, a statement will
be sent for the premium earned. This nolice is sent by the
company that issued the above
company being the one indicated bY
policy, said
6 sereco INSURANoE ooMPANY oF AMERIoA
N OCruERAI INSURANCE COMPANY OF AMEBICA_l I FTRSTNATToNALINSURANcEcoMPANYoFAMERIoA
E SAFECO INSURANCE COMPANY OF ILLINOIS
E SAFECO NATIONAL INSUHANCE COMPANY
E sAFEco LLoYDS INSURANcE coMPANY
f] SAFECO SURPLUS LINES INSURANCE COMPANY
POR:GW:KR:4
r, ,] {1 iggS
3-1340 Col'tMr L
MARKET INFURANICE AGENCY
AGENI/IELEPHONE TYPE OF POLICY POLICY NO,sL 8578242A
POLICY
FOR LOCATION OF SAME
IF
X
cN,7001/DP 1,92 PRINTED IN U S.A,
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