HomeMy WebLinkAboutPermit Septic Tank 1988-07-275rVtqry
Lane County Authori za,ttort for'
RPAIR D(ISTING SPTIC SYSTEM
POR OFFICE USE ONLY
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AIPCK
PRCPOSED USE OF PROPERTY
x Re s idential
C(,nL"nerc iaI
n lndustrral
Publi.c
s'-'BDrvrsroNTpARTjTroN (if applicable)LOTIPARCS:
Llu-hTIOll ADDIIESS STFjiLT
2545 North 38th Street, Springfield, Oregon 97477-1893
L.I']'Y ZIP
STRUCTURES CURR.ENTLY ON PROPERTY
Existing single family dtvelling
I-105 to 42nd, Street, turn off, turn left on lvlarcola Road., turn left on Hayden Bridge Road,
--TREdrfdFS-T6-SfTE
turn left on North 38th Street to site above
DECI,ARED S VALUED'SCRIPTION OF PROPOSED I.IORK - 3I] SPECII'IC
Hepair B<isting Septic Systan
1^/AlER SUPPLY
City
o!EES
na
ProposedExisti
= OF BEDROOMS
na
# OF STORTES
na
TELEPHONE NUMBER
None GivenArt Choate, Same as the iob addres s above
O;i}iERIS NAME AND ADDRESS
CONTRACTORIS NAME AND OSR #
Sane es the above
TELEPHONE NUI4BER
Same
TELEPHONE NUMBER
7M-55ilBill Bovd . 37123 rtllheeler Road, Pleasant HilI, Oregon W455-9732
P=RNTTJo-EE_ETLED To INAME AND ADDRESS)
I HAVE CAREFULLy EXAMINED THE COI'IPLETED APPLICATION l'OR PERMIT, arJ ,lo h.relr): cert.i!), thatr aLl infomation hereon is true and correct, and that f
the following lega1 interest i-n the property,f]orr.t of recordi fca,rra,'l p,r..h""ur;FLuthorized agent.
Eher cerEify that registration with the Builderrs Board is in full force {nd effect as required by ORS 701.055, that if exempt the basis for exempt
is noted hereon, and that only subcontractors ed employees who are .in compliance with ORS 701.055 will be used on this project. I HAVE READ AND
CHECKED THIS APPLICATION IHOROUGHLY.
I f:rther certify that any and aLl work perfomed shall be done in qccorrlair,.: rjLl-, tl.e a..l!r)ance! ot Lae Couty and the Iaws of the State of Oregon
rtaining to the work described herein. and that No OCCUPANCY wilt lE nade of --1r". str,rctrrre Hithoul the pemission of the Building Divi.sion. I fur-
Bilt Boyd 7-26-88
STGNATUR€
Drop-Off
DATENAME (please print)
READ THIS SECTION CAREFULLY. YOUR AUTHORIZATION']AS BEEN BASED ON THE FOLLOWING CONDITIONS:
MinimumSetbacks,CL,f'o,,t-C","id.-irrterrclr-
7-26-88
rnstallation Record rssued? f] Y"= [ N"
of Trenches
COMI1ENTS:
DaLe
Date
on
Tank
Use
Repair Exist ins Septic Svstsn &tIY.reouiredactionCO}d\ENTS
of t)r'il r:fi especi fications
No nl a.nnins
SANITATION3 s. I. #B. P, #
t. l'taximum DePth
col"![lENTS
rear
Lineal EeetInstallation
fl pLextlrnc,u ZoNTNG:Parcel #zone na Partition {Parcel Size na
r oRs 456.80s (1) )
NT OF PUBLIC WORKS LAND MANAGEMENT DIVISION, 687.4061,
EAST 8TH AVENUE, EUGENE, OREGON 97401
E
LANE COUNTY DE
SEE REVERSE FOR INSPECTION INI'ORI\TATION ct4-2s R4
!Z?'^:"r^t'""/2i t t - g 3
tr
sETts:rcKs AliD or:l:i cc:i:irrro::.; ca ;iPPRor,'.:\L }lusr BE STPICT:'r' c!:::tvsD. \'IoLATroN cAl- RasuLT rN REvo-C.i:IO:j OF :iilS ll:ili1l?, CIT;TIO:i UND:R PROVISIO:,iS Oi L,irE -JU:;T'!'.1 INER,\CTION OF.DI:;.lNCC, nND/OR OTITERREUEDIES ALLOI{ED BY LAI/.
liHEli RE..iDY a!)R i:;SPICi ON, CA::68i-!q6a. -l rlIr..Iilf:.: CF,iT L:;sT 24 itOLRS ADV.1::!.8 )JOTICE FOR IIJSpEC-
-cl'-nit:'-lsrj:','" ;rV-rr:-ire-Eire iollowing in:c!attror,.e3dy: lernit number, lob address, cvpeof inspecrron, when rt urlL be ready, you! name anC phoiL- nunller, and an)'spe.j.aI circctions to site.
BUlLDING DIVIS-ION:
l" !om ;
p..FQUI SIf l::SFECTT 3Nj :
I. Foundatio! InsPs:tioni To be made after trenches are excavated and forms erected and when aIInaterials for tirLr toundation are delivered on the lob. iiilcre concrete fron a certral nixingplant (comonly ,ermed "transrt nrxed") is to be used, naterials reed not be on the job.
2. Concrete slab or Under-iloor InsDectiont To be maie after all in-slab or under_fIoor buildingsE;ii-E-e.iurp-ms,:, <::aEult, piplnqtressori-es, and other ancillar!,equipment items are inplace but betore any concrete is poured or floor sreathing install.;C, iniluding the subfloor,
3. IISIi!9 & Insul{:im Inspections: To be made after the roof, all framing, fire blocking, andbracrng arrin -J .re a;aan-Fipes, f irepf aces, cnimneys, and vents are compJ.ete and aIi roughelectrical and p.umbing are approved. A11 walI rnsulation and vapor barriei are in p]ace.
4. Lalh and,/or G!'perT Boqri Inspection: To be made a!-+-er alL lathing anC qypsum board, rnte!ior
and e\'-ericr, is in gl-ace bu: ijeJu-e any plastering is applied and betore- gypsw board jointsand fasteners ar(: taped and finished.
5. Final Inspection: To be made after the building j.s complete and before occupancy.
APPROVAL REQUIRED. :lo uork shall be done on any pall of :he buiLding or structure beyond the pointindicated in each succ(lssive inspection without fi!st obtaining the ipproval of the Uui:-aing off:cj.at.such applovaI sha11 be given cnly after an inspecti.on shaIl have beer mace of each successive stepin the construcr-ion as indicated by each of +-he inspectlcns lequireC.
NoTE: Al.L building oe::mits require inspections for the wolk authorized, such as but not Limited t.o:
A. BLock llall: To l)e made after reinforcing is in p1ace. but before 3ny qrout is poured. ThisiniEEctlSn is re,Juired for each bond beam pour. There wiLl be no approval untii the plunbinqand eLectr:ca1 iilspections have been made and approved.
B. l'lood -stove: To )e made after compLetion of nasonr\' (1f applicable) and when instalLati.on iscom,pfete. rnstaLlation shall be in accordance with an approvea, nati-onaIIy recogni,zec testlngagency and the m,rnulaclurer,s installat.ion lnstructions.
C. llobile Home: An inspection is required after the nobile home is connected to an approvedEEwE?-rcFeptic- rys tem ior setbaci requirements, block j-ng, iooting connec Licn, tieiouns.skr!tj.ng, and plsbing connections.
L. Footi'ngs and piers to comply with state foundation requj.rements for mobi.Le homes or asrecomended )y the manufacLurer.
2. yobile hone ininimum finish floor el-evation shaIl be cert.ified when required by a flood-plain managernent Ietter.
3. Mobile hone :iedowns,-when required, and skirting sha1l be instalLed and ready fcr inspec-tion within rt least 30 days after occupancy. Tiedowns and skirtrng shall be installedper enclosur t.
D. swiming.Pgol: lelow grade when sLeel is in place and before concrete ls poured. Above gradewhen pool rs inscdlfed.
NPPROVED PLA}JS }IUST BE ON THE JOB SITE AT ALL TIMES DURII]C WORXING iiOURS. TIIIS PEfuITIT WILL EXPTREI' h'ORK DOES NOT BEGIN V]I.TIiIN I8O DAYS, OR IF WOBI{ IS SUSPENDED OR ABANDONE! FOR }IORE THAN ],80 DAYS.SUSPENSION OR REVOCATI)N i.1AY OCCUP. IF TIIIS PERMIT WAS ]SSUED ON TIiE BASIS OF INCOI1PLETE OR ERRONEOUS
INFOR-I,IATION.
ANYONE PROCEEDING PirST THE PoIl.,'T OI REOUIRED INSPECTIOIJS wILL DO SO AT TltErR OWN nISK.
SUBSURFITCg .\ND AI,TERNAIIVE SEI{AGE DISPOSAL SYSTE}1S:
I. Permits shall be effective for one year from the Cate of issuance.
2. Upon compJ'eting Lhe construction for whj.ch a perntt has been lssued, the permit holder shalInotify the Lane :ounty Departrent of Planning and L-omnunlty DQielopmcnt bi subnitting theinstallat,ion recrrd f'orm. The Departrent shalt inspecL Lha cohrtf,uction to detcrmj,n; if.it-,-compl:es w!th thl rules contained in Lhis division. 1f the construction does comply with suchruIes, the DeParLment sha.Ll issue a certificale of satisfactory completron tc the permit; holder.- rf the construct!oi- .ioes not cbhply with-su6h-iules, the Depar-Lnentrthall notrFy' tie permrtholder and shall reaurre satisfactory completion before issurnq thc certrfLcf,te. Failure tomeet the rcquircnents for sJt_rsiactory complctron wtthin a reasonable trme constttutes a v1o-Larion of oRs 454.605 ro 454.r45 and Lhis;uLe.
._!l!!f_! - juL.:ur ricc :4rr.1e Dr s;)osaI
Scptic Tank Drainfteld
Intcrior prope!t), lines
EC,jc oi' rcad rrqitt-of-way
Brriliiinq foundation
iiclLs, other hrter sources
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5
50
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10,
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LAXO il^{ACEdf Nr OrvrSrON
o.oirtffi d Pubrts kit
EXISTING BUILDINGS
ON PROPERTY
EFHouseE Barn
EIa GarageE Mobile. HomeE Shed
Other
Please complete all lines inside white boxes, if possibte.
6.
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732
O\T/NERS
216 s-t5 /
-.76 -rtr
jr,^11,tJo CoosTuffi
Dlrectlons to site
from Courthouse
o,/l lharco4o
T L o^/ N-l
FOR MOBILE HOME
PLACEMENT ONLY
No. of Tip-outs
-
No. of Bedrms
/2fr4
'T t-
Ot)
C)f fT,
-S1- f*t 'n "Ff
r?n {u
License #
Model
Year
Size
MAP, PARCEL NUMBER tFound on rlr m!p. ln rh. A!3..rm.nt I Tulrlon D.pr)
l/4 S.ction Tu Lot
l/4 Scclion fil foi-
MAIL PERMIT TO:
l/ 7a
s5
,i /7<1'' L)
-iriE;;iio--
ZIP
0 6
7lZ
SITE ADDB
J
rO
-c?iEn-
S!ctbn
.T.?i6n-
-/7I OWnShlp
Lt c1
Hangc
l-;,c-;-
]aanoc
Land Management Div..tafi can not
be held respontlble lor cvaluationa or
rocommendatlons baecd on lalee,
lneccureta or lncomplata Informatlon
E[\4IJ
t|Je.^ 8", d* R, a
Townrhip
I 0wnshrp
YICINITY MAP
r
Permit No t8-9*Twnshp. I 7 Range
Standard Syste m n Alternative System.El (Specifyt
Job Location (Street Address)
MUST BE IN BLACK INK
Section /f,+'u2
Ta x Lot
-11
lr
Subdivision/Partition # Parcel- Lot- Bloc
I'ETAIL SYSTEM PLOT PLAN AS CONSTRU TEID
Scale I ":46'
" ir/o* Po,e^,t$ -tdsV*P n^" sqsk'"*
9ilrc,o ik""r* rl+^rd er4,i'9 rtr"* U lf
lh, [.r^t t'*sfu^cLo "i V"ll Q"*P/a>
;:t1^
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Ttiuru-,*, > o ( oHk 1fu or'rt isi'u at "
,4"Yrry 7-2ufl'N
lD
so
l.t,
i6o!r
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;- 'i''J
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ro"
lnstaller
Telephone
L inse No.s;Lfiq
/)c
Date-
e
on
USE BLACK INK ONLY 4"FOR I USE:Trench tl Gravel Depth Below Til
Tank Capa Manufa
Measured Distance from Well to T From Drainf ield "& Total Length of Li
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name)- certify that a (fr/fg (Model No.)-Pump
and Nr'lercury Float Switch (Mfg. and No have been installed with this sewage installation
FOR SANITARIAN'SE ON Approved D pproved trN
COMMENT
NS m Corrected
System Capacity rdo al./day S Da
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION when ned by the County Sanitarian, this certificate is
evidenceasperOHS454.665 ofsatisfactorycompletionofasubsurfacesewagedisposalsystemattheabovelocation
lf lnstalled By r-Signature Date-
n(Signature oI Owner)
Applicant's Name I rESS
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