HomeMy WebLinkAboutPermit Septic Tank 1991-10-28
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AUTHORIZATION FORM
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Land Managamanl Division 125 E. 8th AVe; Eugarie.OR ~74cil
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REQUEST
FOR:
SEPTIC REPAIR
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LIVY COOl
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LOCAnON ADDRESS
3635 E. GAME FARM RD.. SPRINGFIELD
8TRUCTUIlES NOW ~ PROP~RTT
HOUSE; ~HED
PROPOSED USE 8E111C INli;,.~~
PRIVATE YES
DESCIIIPTl~ Of Jl'RQlI>Ww Wgfl,~
REPAIR OF FAILING DRAINFIELD
1iiiiCTIOH8 TO SlTI P"OM CQURTHOUa8
WEST END OF E. GAMEFARM RD.; IMMEDIATELY EAST OF STATE POLICY BUILDING.
LARGE WHITE 2-STORY HOUSE WITH GREEN SHUTTERS; 1ST HOUSE ON NORTH SIDE.
""UCANT H.....i ... ADDRUI PHONa
HAROLD E, RICE, 3635 E. GAMEFARM RD., SPRINGFIELD 97477 726-7050
'OWNERS NAUE ... ADDRESS PHONI
HAROLD E. RICE, 3635 E. GM1EFARM RD., SPRINGFIELD 97477 726-7050
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NO. OF DIPLOYUB
CONITRUCTlDff C08TIYAWI:
NO. Of' aEDROOMlI
CQNTRACTOR H.....E
OSR UCEN81 ,
PHONI
~ MAIL PERMIT TO:
-1iARnl n F. RTrF. ~fi~t:j F. GAMEFARtq_ ]In.. SPRIN(;FTF.l.D 0,7477
) NAMI AODIIIISS
I hava carafully read BOTH hat all Information Is trua and correct
HAROLD E. RICE
DAlE
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I PLANNING/ZONING ~l:f:\~.~A~~EW..L Vi _Vo.u,. AUli1~i'I~Cllo'!. 10.. BCC3cl
MINiMUM
f,P..' LlEOAl.101" SETBACKS '''ClflITt.OT.......(': ','.~.0fJ'..
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On Tho i=oll;;~Jlnfl Conc1ll1ono .~
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INTIIIIOR:-.,:;i,.-;" ';:,:.;.RiM
-"R1PARLIH
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A"ROVED .'t, :-cATe":'
> SANITATION lax; )$O.~i<~~;':~::E,?~,:~'p~jq'r
e..L I B.P.' IHST, flEe I83'D TANK 8IU UN. ~T: 01. MAX, T~ DEPTH, :', ,'UGHT.. IF eVBrPl ,AIt.s, YOU _ ,.: _ "_ :';_._ _ "::"
J)..alh~ 'l:o J;pP,.t!,'t;ocJL 6'FGJJ .....< 'b=~"~~~":::,,:"~ ..... ..
CO....jHTS( ;., ~,," .' .. _': ': ,/.:' ..;',.-. -:.::":, IHBTAU.U Pf:II.PlRIIIT NUMlIiflI:: ..
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I. ~r' YeJ:;(~S n__A~rtI~ J-r ,'lft:;..;,,}f...OVE. "'.~...,. 1$./a.gftr;
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BUILDING i.> replO""Cffc:l.)p~d~,.,.k t;6...bf:..pro~'f.~clt::>"..,eek
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FEES DUE: $
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APPROVED BY: ~t77/~
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DATE
10/ 2. ~J en
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CALL FOR (fIJSPECT/ONS (SEE BACt( OF FORfII FOR (fIJSTRUCTIONSj 687-4065
:., SEPTIC permlls Bre good for one year. ALL ofher permits Blfplre Bllor 180 days un/ess Inspacl/ons Bre currenf. _
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VIOLATIONS
SETBACKS AND onmR CONDmONS OP APPROVAL MUST SD STRICIL Y OBSERVED. VIOLATION CAN RBSULT IN RBVOCAll0N OPnDS PERMrr.
CITATIONS MAYBE ISSUFD UNDER nIB PROVISIONS OF LANB coum'Y'S INRAcnoN ORDINANCE ANDjOR 01lIER REMlIDIES AIJ.OWBD BY LAW.
.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following infonnation ready when you call: 6874065
Permit number - Job address - Type of inspection required When it will be ready
Your name and phone nwnber - Any special directions to the site
PUBLIC OFFICIAL RIGIIT 1'0 TRESPASS ON PRIVATE PltOPERTY ORB 215.010
POWER TO ENTER UPONLAND. nm COMMISSION, AND ANY OFrrs MEMBERS. OPFICElS AND EMPLOYES, IN nlBPBRPORMANCB OPnmIR PUNcnONS,MA Y
ENTER UPON ANY LAND AND MAXBBXAMlNATIONS AND SURVEYS AND PLACB AND MAINTAIN nm NBCBSSAAY MONUMBNTS AND MARKERS TIiBREON.
REQUIRED INSPECI10NS
FOUNDATION INSPECI10N: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND PIPING INSPECI10N: To be made after all underground piping has been installed, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECI10N: To be made after all in-slab or under-floc" building service equipmen~ condui~ 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 INSPECI10N: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPECI10N: To be made after all plumbing rough-in is in place, prior to being covered.
FRAMING INSPECI10N: To be made after the all framing, flTe 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 INSPECI10N: To be made after all insulation and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPECI10N: 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 and fasleners are taped and finished.
ADDITIONAL INSPECTIONS MAY BE REQUIRED, such as but not limited 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 been made and approved.
FINAL MECHANICAL INSPECI10N: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPECI10N: To be made just prior to the building. structure or remodeled area being occupied.
FINAL BUILDING INSPECI10N: To be made after finish grading and the building, structure or remodeled area is completed and ready for occupancy.
MOBILEjMANUFAcruRED HOMES: An inspection is required after the mobile home is connected to an approved sewer or septic
system, prior to covering sewer or waler lines, for setback requirements. blocking, tiedowns and plumbing connections.
Footings and piers to comply with State foundation requirements for mobile homes or as recommended by the manufacturer.
Minimum fmished 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.
APPROVAL 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 only after an inspection shall have been made of each successive step in the construction
as indicated by each of the inspections required.
APPROVED PLANS MUST BE ON TIlE JOB SITE AT ALL TIMES DURING WORKING HOURS.
TIllS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITIIlN 180 DAYS, OR IF WORK IS S, urrl'V OR ABANDONED FOR MORE TIlAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR IF TIllS PERMIT WAS ISSUED ON TIlE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING PAST Il'HE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
Your signature on'the fronl of this fonn verifies the following: I HAVE CAREFULLY EXAMINED TIDS COMPLETED APPLICATION, and do
hereby certify that all infonnation hereon is true and correct, and that I have a legal interest in the property as owner of record or authorized agent. I
furthcr certify that 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 to the work described herein. I further certify that if I am not the owner of the r"f"-A~j, my registration with the Builders Board is in full force
and effect as required by ORS 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.
SUBSURFACE & ALTERNATIVE SEW AGE DISPOSAL SYSTEMS:
When subsurface construction is complete. the pennit holder shall notify the County Land Management Division by submitting the installation record
fonn. An inspection will be made by a qualified sanitarian. If construction complies with all rules a certificate of completion will be issued to the permit
holder. If construction does not comply with rules. the pennit holder will be notified, and all corrections shall be made before a certificate of completion
will be issued. Failure to meet satisfactory completion within the allotted time constitutes a violation of ORS 454.605 to 454.745 and this rule.
SUBSURFACE SEWAGE DISPOSAL SETBACKS SEPTIC TANK
From: Interior property lines 10'
Edge ofroad right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
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iironmental Health Services
125 East 81b AwnuG
Eugene, Oregon 97401
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white boxes,
if possible.
Of'}r IS 91
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ZIP
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CITY
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OWNER OF PROPERTY (II no-I ..me .. .bow,)
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OWNERS ADDRESS <II nol ..m. a. abov.)
ZIP
t;UNIHAL:IUH
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MAP, PARCEL NUMBER
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SEPTIC INSTALLED
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c::J No
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land Management Dlv. staff can
not be held responsible for
evaluations or recommendations
based on falso, Inaccurate or
Incomplete Information
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LANE COUNTY DEPT ENV MGT RECEIPT ~ 314191 DATE 1015.i1
. APPLICANT RICE. HAROLD ADDR 3635 E. GAME FARM RD.. SPRINGFIELD~
TL~ 1703150002900 SUBDIV LOT BLK
NEW BLDG TYPE' USE R BDRMS . UNITS 001 STORIES ~BLDGS 001 PHONE 726 7050
. OWNER NME RICE. HAROLD ADDR 3635 E. GAME FARM RD.. SPRINGFIELD.
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE D.AY~
1'-1': 'BP ,'\ I
. BP f,.
BP
BP
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PL
. MECH
SUR
PCK
SDS
SDEQ
~FIX/BATH:
SWR: FT. WTR:
MECHANICAL FEE
STATE SURCHARGE
'PLAN CHECK FEE
FT.
RAIN:
FT
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5%
25r.
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LC 314191 SDSR
FEE
75.00
10.00
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CATG: PLN
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TAKEN BY MLC
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SDS
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EST.
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COMPLETION DATE
DEPOSIT **
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LANE COUNTY DEPT ENV MGT RECEIPT I 314191 DATE 101~nl
APPLICANT I~ICE, HAROLD ADDr< 363~> E., GAME FArm FW., SPI~INGFIEl..D.
'TlI 1703150002900 SUBDIV LOT BLK
NEW BlOG TYPE USE R BDRMS 0 UNITS 001 STORIES IBlDGS 001 PHONE 726 7050
OWNER NME r::Ief.::, HAFWL.D ADDF< U,35 E. GAME FI~r~M I'm., SPRINGFIELD.
conE AF'PI... NO ACTION OESCr::IPTION S(, FT . UNIT COST VAL.UATION . FEE j).!iI'lf~'
BP .5u.
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BF'
BP
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BY MI..C
DEPOSITu
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i0.00 BUM"
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85.00 CI<
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. MECH
~:TIX/B{,TH :
SWR: FT. WTR:
MECHANICAL FEE
ST (, TE Sl.mCHAr~GE
PU~N CHECK I:'I:'T
FT. F;(~IN:
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SOS
SDEQ
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L.G 314; 91 SDsr~
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