HomeMy WebLinkAboutPermit Septic Tank 1997-04-21UaBfs?R
4
PERMIT # ^(F%f-?7
INSTALL SAND FILTER SEPTIC SYSTEMREAUEST
FOB
I have carefully read BOTH
LYNN DANCER
des of this
PRIAIT NA}'€
certify that all inlormation is true and correcth
OATE
READ CAREFULLYI Your Authorlzation ls Based On The Followlng Conditlons
FEES DUE: $APPROVED BY:OATE L{
oALL FOR |NSPECTIONS (SEE BACK OF FORM FOR INSTBUCTTONS) 687-406s
SEPTIC permits are good for one year. ALL other permits expire alter 180 days unless lnspectlons are current
LMD 040 Rev. 6/92
s. 47TH ST., SOUTH ON S. 47TH ST., TO END OF ROAD.
18
INSTALL SAND FILTER SEPTfC SYSTEM
'"*' 9r2- 9733, SA-I'{E AS THE JOB ADDRESS ABOVE
+s%bzga PH.NE
8 g6-3282
0
PRreEO6E }€. OF STORESWAERNTMD
CITY
ffiqffiEDUIORX NA,Gruffi
PHONE SAME
LYNN
5
RES.
FROI4 JASPER
A7'.tIJ ST., SPRTNGFTELD, OREGON 97478
OIilNEBS NAilEA ADORESS
SAME AS THE ABOVE
TO THE OWNER AT THE JOB ADDRESS ABOVE
/ -'
VIOLATIONS
SETBACKSA},IDOTTIERCONDITIONSOFAEROVALMUSTBBSIBICILYODII8RVD. YPI"ATIONCANNE$]LTNNBVOCATIONOPTIIIIIPBRMIT.
CITATIONS MAY BE ISSI,'ED T'NDER, TIIB PROVtsrcNS OF LAI{B COI'NTY'S INFR^CTTON ONDINANCB AND/OR, OTI{BN, RBMEDIBS AI.LOWED BY IJ\W.
Permit number - Job address - Type of inspection required - When it will be ready
Your name and phone nrmrber - Any special directions to the site
DRAINFIELD
10'
l0'
10'
100'
A MIMMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following information ready when you call: 6874M5
powERroBNrBRUpoNLAND. "*""m,!f"iTlB*i+'3Flllffilf33#&!'lffi"rffil3H.Bli,fi'*?r"-" *oprHBIRFtNcrroNs,M^y
ENTER UPON ANY LAND AND MAXE EXAI\{INATIONS AND SURVEYS A},lD ll-ACB A}.ID MAINT IN THB NBCBSSARY MONT ME{TS AND MAR.ERS THERBON.
REQI.'IRED INSPECTIONS
FOLTNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
LINDERGROLTND PIPING INSPECTION: To be made after all underground piping has been installed, pnor to any baclfill.
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 installd, 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, fte blocking, bracing and roof are in place and all pipes, chimneys and ve,lrts ue complete
and the rough elecrical, plumbhg, and mechanical inspections have bee,n made and approved.
INSULATION INSPECTION: To be made after all insulation 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 boardjoins and fastaner are taped and finished.
ADDITIONAL INSPECTIONS MAY BE REQUIRED, such as but not limircd to;
BLOCK WALL: To be made after reinforcing is in place but before any grout is poured The inspection is required for each bond beam pour. There
will be no approval until the plumbing and electrical inspections have beenmade and app,roved.
FINAL MECHANICAL INSPECTION: To be made just prior to the stnrcture or remodeled area being occupied and prior to operating any equipmenr
EINAL PLUMBING INSPECTION: To be made just prior to the building, stnrcEre or remodeled area being occupied.
FINAL BLTILDING INSPECTION: To be mader after finish gfading and the building, structure or remodeled rea is completed urd ready for occupancy.
MOBILEA,IANUFACTURED HOMES: An inspection is required after the mobile home is connected to an approved sewer or septic
system, prior to covering sewer or water lines, fu setback requirements, blocking, tiedowns and plumbing connections.
Footings and piers to comply with Sute foundation requirenrents for mobile homes or as recotnmended by the mmufacnrrer.
Minimum finished floor elevation shall be certified when required by Floodplain Manageme,nt
Tiedowns, if required, shall be installed and ready for inspection within 30 days after occupancy. Tiedowns shall be installed per etrclosure.
APPROYAL REQIIIRED
No work shall be done on any part of the building or stnrcure beyurd the point indicated in each successive inspection without first obtaining the
spprovar of rhe building official. Such approval shall be given only after an inspection shall have been made of each successive step in tlrc construction
as indicated by each o(ttre inspections required.
i ' APPRovEDpr-ANSMUSTBBoNTHEJoBSTTEATAITTTMFSDURINGWoRKINGHouRS. i'" "i
THIS PERMIT WII.I D(PIRE IF WORK DOES NOT BEGIN WTTHIN I8O DAYS, OR IF WORK IS STPPPED OR ABANDONED FO"R'MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCI'R IF TIIIS PERNIIT IVAS ISSUED ON TI{E BASTTOF SICOMPLETE OR ERRONdOUS IMORMATION.
ANYONE PROCEEDING pAST.THE POINT OFREQT.,'TREDINSPECTIONS WILL DO SO AT THEIR OWNRISK. '
.,1,
Youi sigriature bn tha hont of this form verifies 0re following: I HAVE CAREFULLY E)(AMINED TItrS COI\,{PLETED APPLICAfiON md do
hereby certify ttrat aH information hercon is tnre and @rrcct, and lhat I have a legal interest in the property as omer of record or authorized agent. I
furttrer certify ttrat any and all work performed shall be done in accordance with the Ordinances of Lane County and the laws of the State of Oregon per-
taining !o the work described herein. I fur0rer certiff tlnt if I am not the owner of the property, my registration with the Builders Board is in full force
and effect as required by ORS 701.055, and that if exemp the basis for the exemption is noted hereon, srd that only zubcontractors and employees who
are in compliance with ORS 701.005 will be used on the job.
SUBSURT'ACE & AI,TERNATIYE SEWAGE DISPOSAL SYSTEMS:
When subsruface constnrction is complete, the permit holder shall notify the County Land Management Division by submitting the installation record
form. An inspcction will be made by a qualified sanitarian. If construction complies wi0r all rules a certificate of completion will be issued to the permit
holder. If construction dees not comply with rules, the permit holder will be notified, and all corrections shall be made before a certificate of completion
will be issued. Failure tp mcet satisfactory completion within the giloned drne constitutes a violation of ORS 454.605 to 454.745 and this nrle.
SUBSURF'ACE STWACS DISPOSAL SETBACKS ' SEPTIC TANK
From: Interior property lines 10'
Edgeofroadright-of-way l0'
Building foundation 5'
Wells or other water sources 50'
I
\ .!v,-'nJAi r ala+Ef,illQ*/lffil
, r rr-,t6.r Jh{tfl
To Be Completed By lnstaller:
PERMIT ISSUED TO:
(Date received)
,dffigs
Depadmenf( Eii!.iftIilfElthffhf to perfom an rnspedion of the compl6ted construclion ansr th6 oficial notie date, unless the oepartmont (or AgEnt) etects to waivs the
roquestforth6pro-covorhsp€ciion. Plgasecompleteallthms6ctionsofthafommdrslumtoLaneCountvEnvironmental HEalth. 125E.8thAve..Euoen6.Oreoon.97401.
SECTION 1: BASIG INFORMATION
Permit #9rnt -?-05, /.ffiMap/T ax Lot #
J
6
Name:iling
Property ress:
TOTAL #: Beciroom Living Units Basement: Yes_ No
WATER SUPPLY: Public Il lndividual o Community o Other (Name)
Depth Rock Beneath Drain Line Cr in.; Depth Rock r Drai
SECTION 2: Materials List (ldentify and list all materials used in system;:
SEPTIC TANK: I Concrete o Poly o Metal .C
Manufacturer I ltt'linw,toTfi-.6n*r4Tor. Total L-iqUid C-apacity ,/(oo g dl.- ,-i& n'"
Distance from Dwelling l4 ft.; Effluent Sewer ASTM Distance from well f** ft.
DRAINFIELD:
Total LinearfeetJg-
-;
Drainfield Pipe (ASTM#),M-eaderPipe(ASrM flW
aiL
n Linejlin
def
that a
I No.p and Mercury Float
and No.)Of nmaa 3 l have been installed with this sewage installati
Cycle {5 gal.
on
(Complete as Applicable): Working Capacity of Chamber o l. Gallons per
"Working Ca remain alarm has dd
Distance of WELL from Closest Portion of DRAINF D
Mfg./Type/Size of Rock Filter M
PUMP SYSTEM:
(Mfg.)
Switch (Mfg
sig 4.c-
OTHER: (Materials not listed above
t.
L-ll-fz
FOR SANITARIAN'S USE ONLY:
I
;(Vstem Approved o System Disapproved o Needs Correction
o System Gorrected; Date:
sig
INSTALLATION RECORD &
Capacity
OF SATISFACTORY COMPLETION. \Men signed by the County Sanitarian, this certificate is
454.665 of satisfactory completion of a subsurface sewage disposal system at the above location.
?
(over)
evidenceJs per ORS
g6g -77Permit #
SECTION 3:
AS-BUILT PLAN OF THE CONSTRUCTED SYSTEM. Show the following: North arrow, septic system
referenced to a flxed point, such as, building foundation or property corner, property lines, wells and water lines
within 200 ft., drive orwalk-ways, all buildings, property dimensions, streams, ponds, cuts, escarpments (>50%
slopes). lnclude final grade shots of ends of trenches, distribution box, and septic tank outlet elevation.
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I certify the informdtion provided in this notice is
correct, 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
EL 340-73-025(3)
lnstaller (Ptease
and fo it
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Telephone
License
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(Title as shown on DEQ license)
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APPLICATION* BP E6E.97
LOCAflON:783 S. '071h 8t.
541 6Ee 3732
PHONE
Pny*/cl--s-
HOLD SLIP
I.iNG
couifi(il
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Lynn Dancar ,
783 s. 47th,
Springfleld, OR.97478
LANE COUNTY ENVIRONMENTAL HEALTH IS HOLOING YOUR
PERMIT APPLICATION FOR THE FOLLOWING REASON:
Your rite requlrea a sand frltrr sewage disposrl aystem, Plcase submit dctailad cnglneored plana
to your sand
AE!:1L199I
DATE
IF NO RESPONEE HAS BEEN RECEMEO REGARDINO THI8 MATTER WTHIN 30 DAY8 THE
IANE COUNTY ENVIRONMENTAL HEALTH
Court House / Public Servlca Building
125 East 8th Avenue
Eugene Oregon 974a1
I Od 3Nl ldV'* ,/\Irf gO: eO *6 'lA '?O
W: 3 ' - NE CoUNTY DEPT ENV MGT REC--PT # e6897 DATE O4OL97
APPLICANT DANCER, LYNN ADDR 783 S. 47"r._ ST., SPRINGFIELD, OREGONrL# L8O205l_l_00500 suBDrv 600 LoT BLK
NEW BLDG TYPE USE R BDRMS O UNITS OO]- STORIES #BLDGS OO1 PHONE 912 8733
owNER NME DANCER, LYNN ADDR 783 S. 47TH ST., SPRTNGFIELD, OREGONcoDE APPL NO ACTTON DESCRTPTTON SQ FT UNrT COST VALUATION FEE DAYS
BP
BP
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PL #FIXIBATH:
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SWR: FT. WTR:
MECHANICAL FEE
STATE SURCHARGE
PLAN CHECK FEE
FT. RATN:
sz
2sz
/ sr oTR
DEPOSIT **
FT
535. OO
30.00
95.25
5. 00
765.25 CK
CATG: PLN
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EST.
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COMPLETION DATE
ISS
2 31-
HOLD SLIP
LANE
CflJNTYtr
APPLICATION# BP 868.97
LOCATION: 783 S. 47th St.
Lynn Dancer
783 S. 47th.
Springfield, OR. 97478
LANE COUNTY ENVIRONMENTAL HEALTH IS HOLDING YOUR
PERMIT APPLIGATION FOR THE FOLLOWING REASON:
your site requires a sand firter sewage disposar system. prease submit detaired engineered plans
to your sand filter..
SIGNATURE
Aoril 14. 1997
DATE
\
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Mondavfridav 8:00 to 9:00
OFFICE HOURS
541 682 3752
.\
PHONE
IF NO RESPONSE HAS BEEN RECEMED REGARDING THIS.IVIATTER WITHIN 30 DAYS THE
APPLICATION MAY BE DENIED
LANE COUNTY ENVIRONMENTAL HEALTH
Court House / Public Service Building
125 East 8th Avenue
Eugene Oregon 97401
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,tZtl St
Yorr Addros
4ii,u*1,"))eiil-7-J
Owner of Parcel (if not same as above)
(if not same as above)
CCB Licens€ #
Your mrzL
zip
Phone
zip
Phone
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?79
Sbedl- stl:stis
tu&dng&.il&rytqh*
porerneaGs ondr nopcrly
-
House
-
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Garage
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Mobile Home
X sn"o
SEPTIC INSTALLED?-^
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IfrAP, PARCEL NUMBER
(Fourd on lrilnrpa ln lh. Ar...rllnrn t T.nuon
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Dlrcctlons to sfte lrom
nearest maln lntercectlon
AlLd s. 47d sf:
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s+, L eLd e{
RonJ
Sffe Address
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Mail Permit Tot
7
ZP
For Moblle Home
stans with X)
Pla Only
x-
Brand
Year
Size
No. ol Bedrms
Ucense* (No.
Home
Water
LilD staff can llOT be held
responslble for evaluatlons or
recommendatlons based on
talse, lnaccurate or lncom-
plete lnformatlon.
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