HomeMy WebLinkAboutMiscellaneous Plans 1980-2-1
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VICINITY MAP
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Job location (Street, mile post)/ 1/ ()
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Date:
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FOR SANITAR~'S(.:!:9l)':~ystem API:>ro~ed
COMMENTS: I -I,l(, . IVI 0. ~i-\
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- /, , - -Signature:
FOR INSTAllER' SE: Trench Depth ~o H Filler Depth Below Tile ~"
Tank Capacity J{lOD~ Manufacturer WI L L CLlI" ~\'\'~ (.., i'"A-,\ "''\'o-.... .l2..
Measured distance to well from ta l~ IU'^">.,,-<L from drainfiel,l JuCJVI.-<Z-
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PLOT PLAN
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INSTAllATION RECORD AND CERTIFICATE OF SATISFACTORY COMPLETION
When signed by the County Sanitarian, this certificate is evidence as per ORS 454.665 of sat-
isfactory completion of a subsurface sewage disposal system at the above location.
Return this form to: Permit Processing Section, Department of Environmental Management,
Public Service Building, 125 East 8th Avenue, Eugene 97401
C55.11
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FINAL INSTALLATION RECORD FOR PERMIT # u,-n 7,->;0
i):1Ihdl~('1()k.OIl)s>k;. INSTALLER /appllcoA!-
III{) r'J? 1i:!f'1.1' {J/~ IJ lO . ADDRESS
. <:,;\/1j(,'111 ('ie fd N2 01477 ZIP
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Your CBr-t~ficate of Satisfactory ComplBtion for the abovB rBfBrencBd
installation cannot be approvBd until the following corrections arB made:
A. Township, rangB, section and tax lot description
B. AddrBSS or street, road, etc.
C. Applicant's namB/mailing address
D. Installer's signature
E. Distances from tank & drainfiB1d to well
F. Pump & switch specification statement on plot plan
G. Vicinity map
H. Additional measurBments,needed
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1. INCOMPLETE FORM I INADEQUATE PLOT PLAN
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K. Other
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3~ CONSTRUCTION
t' A. Water levB1 d-box 1J Y
B. Grout box(es) (inside and out) {Il{J)j.
.,~C. Non-approved materials used in effluent sewer ~., H
'" ~.-D. TrenchBs covered ~ q Iv ,
O~ 'VI /FB. I ncorrBct grade on trench bottom and/or dra in 1 in I~' I' =..C
IncorrBct trBnch dep.th . ., ' 7?7 f,-
b'l /". 'Other Itd.11'ffW d/lfillAI7cld (U-tJ~ i j-'.fJd ""'::,d Vl@ ~
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If the necBssary corrections are not made within ~(J days, the n~ ~o~
CBrtificate of Satisfactory Completion will be denied. L"I..\\ '" I
c.c. Applicant Signature <--M.f//;1J 'h1. ~JJiJ!riPlllflf1l1 Date l? /fltlu/1!JD
Phone /;;0J-.51(/)() 8:00 -~9:00 A.M. / '
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WatBr Pollution Control
125 East 8th Avenue I
(503)687-4061
Division I EnvironmBntal ManagBment Department
Public Service Building I EugenB, Oregon 97401
I Wats Line 1-800-452-6379 .
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CONSTRUCTION PERMIT # 713-t:J r::l , ~
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SubdivIsion: X.,,\ ,r' ",
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This permit for the referenced property is hereby" . 'pr2C)":7f:' . Setbacks and other co'ndFtions of approval must be strictly observed. Violation can
result in revocation of this permit, citation under provisioni~f Lane County's Infraction Ordinance, and/or other remedies allowed by law.
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I '. . ..,. Telephone:1f/706-70fiX__74G_S200
Telephone:
Telephone:
72.~- (ol.j~ (wortk\
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J0B ADDRESS:
TRS, TL.=
POST THIS PERMIT ON MAIN BUILDING AT SITE
~!~') ~c r.:UC 12?~\.':i, S,;;!?l::JGv~:)~d
~7-03-23.4.4 11.:2(;3 Hai), ]2iJ~
Applicant/Address: E!:,vkl ri;t"-[I6::;stl~. ii32~l~ S~u0~. s~7i;fla?Jc~cl. 6:1 9?G7t-
Owner/Address: C:~[;,Q r.:..~t:C:o;}:d. 2GCD C.; SCi(;:;;:)~. S:;?k~Y~cTId. 0:1 ryjtrn
Contractor(Address: !2:.::70UC lm~Ucii' S"~:;D .
Contractor s OS # nS!~ Total ConstructIon Value:
.onstruction approved by this permit:
S~::QUo tn6 [:Z~nO 1::'-:::) X0 IT es DeJ--F1co~Hr-o
S~..;&(:t.!i"(;S l~c:J c:J ~b Dj'(;;...;;r~y: 1:'::-i:Cl :2 [708 t;::;,::zaS G 1 tJru
Water Supply: ~:::l~ # Bedrooms: ..,
PLANNING DIVISION
WATER POLLUTION
CONTROL DIVISION
,t- tbacks
, terior property lines
Edge of road ri9ht-of.way
Buildin9 foundation
Wells, other water sources
# Plumbing Fixtures: '"
# Employees:
1'2
Zoning: (..;$, Partitioning # no Parcel # CO
Minimum'Yequired structural setbacks, from: centerline of road, front: ~Oo
side exterior: ; interior property lines: lla' ;rear property line: 20'
Special Instructions: CL'?-79-C1l1l'';j)VG,,;:;j
Parcel Size: 40 ClG~B
; centerline of road,
For information call 687.4394,
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Any alteration of the
natural conditions in
the area aOornvArl fmthl') rfr~in.
field or repiacement area will
gal. min,V~WtiFtIlf(ffi'<eapacity;
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Site Inspection # Q9-!)ZIJ . Installation specifications: [/,0::3
;/'G!J lineal feet of drainfield required; max. dept)1 of trenches: :'<CD
Special Instructions:. ,q,:Q~aH ,:"j ;~~:::l] c;~9~K:):l~~O 5J7G~O ~O %(::1 O;'\D
G;2~~v~c::1 0 DtCi: [)10 ~':::v ~':':;'jJd 2-A-O. [:O\:Jm~" r 1I.~' GG~ :~QC~
C700 ~C~~~ G~\Of1Qld C:J ov ~Jl1.
Septic Tank
10'
10'
5'
50'
Drainfield
10'
10'
10'
100'
For information callr;m~<")w;
between 8:00 - 9:00 a,m., r:"nr'""l
CONSTRUCTION Type of Construction: [:1 Group: r.:l Fire Zone: ::l Use Classification: S:FD
PERMITS/INSPECTION Instructions: &:C::~\;)C3 eel ?'\Gro CO 0=)0.11 t1~CD GWW VC::;)~<;:~C-l \'\Xj:J~crc::::::JW VO? [::;')~]c Cc::::::s
DIVISION c? w VC"'.c:-::-::::c"J::1 D.v ct:J C::::0V~t.7\)7. IT\Nv~6 13:I9~L:O rn ~:1iJU'C::]. Vc:? G~W ~G ku.&xl wilCD~8 0 ~IJSJ
[i.'1Zf'{,O OruD. A d!CJ~c:::J v~:J~>il ~"1JC:;7 oki7c:l~o 0'"1 iYJY.G9 '?w~ g['..J]] l:::> CDVZ1v~o() ~? C::J 7lcccl DIO~o
l:I::c:';:::-'f _~C ].c';'i;Q7. R'Jzw]o c...--,,)'J]o r~8~0'0'fr't" '; C~09. ('0.0-::'::3 c;J1? ccl0GGD. C='l rqu'Jm<l t;; Il]ccj p[;:l~o
For pans In ormation call C0'i-'Jii:.J between: a.m. and: a,m" E.;'::-;~ C":C;:'::=::JC.
For inspections (see back of this permit) call 687-4065 between 8:00 a,m, and 5:00 p.m.
Directions to Site:
no
Date Issued: 0/'X'S:!GJ
C55-13
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
COURTHOUSE I PUBLIC SERVICE BUILDING
125 EAST 8TH AVENUE. EUGENE, OREGON 97401
By:
bne county
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Vicinity Map
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