HomeMy WebLinkAboutPermit Septic Tank 1991-10-17 (2)
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AUTHORIZATION FORM ;>3/76 -;7/
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REQUEST
FOR:
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Land Managamant Olvlalon 125 E, 8th Ave, Eugene, OR 97401 '".
lAD DRESSING,
REPAIR EXISTING SEPTIC SYSTEM
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f TOWNSHIP 18 UNOi 03 SECTION 02 . ~ BECTlOH TAX LOT 17 0 0 SU8t1VISIOM 1 PARTlTlOH
LOCATION ADDRESS
210 DORRIS STREET, SPRINGFIELD. OREGON 97477
STRUCTURES NOW ON PROPERTY
EXISTING SINGLE FAMILY DWELLING. SHED
iiioPOSED usa SEPTIC I\ISTALLEO WATER I\ISTALUiD NO. OF STORlEB NO. Of EllP'wiiEs
PR IVATE USE
PESCRlI'nOH 01' PROPOSED WORK
REPAIR EXISTING SEPTIC SYSTEM (DRAINFIELD)
L.01/PAflc:u. -.ClCK
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COfCSTJllET1DtIl COST/YAW&
NO. Of' BECROOlII8
DlAlicrlONS TO 81111 I"ROII COUATHOUS8
OUTH SOUTN SECOND STREET. TO DORIS STREET. LEFT ON DORRIS STREET. FIRST
HOUSE ON DORRIS STREET PAST EMPTY FIELD.
APPUCANT NAME . ADDRESS
VIRGIL TAYLOR, 1960 NORTH 18TH STREET, SPRINGFIELD. OREGON
IWOH1"ACTOA flAME
NA
~ MAIl. PERMIT TO:
APPLICANT WANTS TO PICK-UP PERMIT
~ H..E '..'''B. l {
I have cerefully reed BOTH sides of this ~IO"ltJ~"jher~1J~~at r#~ Information
VIRGIL TAYLOR ..,.;...:. ~l-GiU f rr7
'" PRINTN.W!j -~ '{ { / '. DATIj
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NA
97"llii 747-1098
PHON&
SAME
PHONI
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19 true and correct ..
OWNERS NAMe: . AOORE88
SAME AS THE ABOVE
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. PLANNING/ZONING
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MINIMUM
SETBACKS
FRONT ~TLWI
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'EAR
RIPARIAN
CQ..MOITIl
NO PLANNING ACTION REQUIRED.
REPAIR OF EXISTING SEPTIC SYSTEf4 ONLY.
) SANITATION
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ROGER HOLLI S
hAtI!
10/16/91
/~fo'f.e:t:.-ki l.:::n 1<{ 0 lNBTALL lBllT. ....... P"
r 1..J41Q6 .. /'JlJ qC- . APPROVED PLOT PUN. OATIlD
. ~_ 0 THI 8YIT~ .PPURe TO .. WOfWMO
SJ.' I.P.' INST.R~''';J''l.. . T,t.HK81ZE UN.~T'D' ,.........TR tlEPTlf..,. RlOHT. lFarsTEM'~u.yOU,
~~ I. JJ ..,o'i...A ."It It_._ .... .L:~: ' .. ' AL....,-.:, MUIT APPlY FOR A "IPolIA P&RiIIY
~f'hln .......T\..~ ~.t...t),. (l.'#')r...l. ....:-.. H...-'::OHOOM;TOEXI8TlHQ8Y8TOI
COil' ct-; tnih 1-D lJ~lrlJ~ ~ ~.{.jfII):,R -iJ?:&...:~7"11- (\,S
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)n . "PP"OVIO 8Y;
BUILDING
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APPROVED BY:
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FEES DUE: $
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DATE 17M (/
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CALL FOR INSPEC7IONS (S'=E BACI( OF 1"0:'1[.1 FOR INSTRUCTIONS) 687-4065
~EP77C porml~octo_fJO~d -'or 0."0 yoar. ALl. olhsr permits o"plro ElftrJ~ 18~'tEl!..S':fI/C'JO!J -'nsfJ".etlonr;~ro cUl"ront~
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VIOLATIONS
SBTBACKS AND OTHBR CONDmONS OF APPROVAL MUSTBB snuCIL YOBSBRVED. VIOLATION CAN RBSUL TEN RBVQCA.ll0N OFniIS PERMIT.
CrrATlONS MAY DB lSSUBD UNDER nm PROVISIONS OPLANB COUNTY'S INI'1tACJ1ON ORDINANCE AND/OR. OTHER REMEDIES AlLOWED BY LAW.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECflON REQUESTS
Have the following infonnation ready when you call: 687-4065
Permit number - Job address - Type of inspection required When it will be ready
Your name and phone number - Any special directions to the site
PUBLIC omCIAL RIGIn'TO TRESPASS ON PRIVATE PROPERTYORS n!.oSD
POWER TO ENTER UPON LAND. nm COMMiSSION, AND ANY OF rrs MEMBERS, OFPICERS AND EMPLOYES, IN nIB PRRPORMANCB OPnmIRPUNCllONS. MAY
BNTBR UPON ANY LAND AND MAKE EXAMINATIONS AND SURVEYS AND PLACB AND MAINTAIN nm NECESSARY MONUMBNTS AND MARKERS TImRI!ON.
REQUIRED INSPEcrIONS
FOUNDATION INSPEcrION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND PIPING INSPEcrION: To be made after all underground piping has been installed, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPEcrION: 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 INSPEcrION: To be made after all ducting and gas piping has been installed and prior to being covered.
ROUGH PLUMBING INSPEcrION: To be made after aU plumbing rough-in is in place, prior to being covered.
FRAMING INSPEcrION: To be made after the all framing, fJre blocking, bracing and roof are in place and all pipes, chimneys and vents ore complete
and the rough electrical, plumbing, and mechanical inspections have been made and approved.
INSULATION INSPEcrION: To be made after all insulation and vapor barriers are in place, prior to covering.
LATH AND/OR GYPSUM BOARD INSPEcrION: 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 fasteners are taped and finished.
ADDITIONAL INSPECflONS MAY BE REQUIRED, such as but not limited to;
BWCK 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 INSPEcrION: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPEcrION: To be made just prior to the building, structure or remodeled orea being occupied.
FINAL BUILDING INSPEcrION: To be made after fmish grading and the building, structure or remodeled orea is completed and ready for oecupancy.
MOB1LE/MANUFACfURED 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. for setback requirements, blocking, tiedowns and plmnbing connections.
Footings and piers to comply with State foundation requirements for mobile homes or as recommended by the manufacturer.
Minimum futished 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 fust 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 AU. TIMES DURING WORKING HOURS.
TIllS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITHJN 180 DAYS, OR IF WORK IS S ourrr.u 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.
1 '.
ANYONE PROCEEDING PAST THE POINT OF REQUIRED INSPECflONS '(VILL DO SO AT THEIR OWN RIS:..
Your signature on the front ofthis form verifies the following: I HAVE CAREFULLY EXAMINED TIllS 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
furthcr certify that any and all work .....:_....ed 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'.r..'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 permit 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 pennit
holder. If construction does not comply with rules, thc.permit 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 SEW AGE DISPOSAL SETBACKS SEPTIC TANK
From: interior property lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
.
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VICINITY MAP
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Job Location (Street,milepost).:2/!' Pn,if'RJ5 5'T .5/'7.0
SUbdivision4f/lf/.:-lt:f2.k jTJ f'l ~-r.r rYJl= t-V'II.I, JI/?-.IJT5 Lotll-l-'/-2 Block.L2.-
FOR SAN IT AR IAN'S USE ON L Y: 0 System Approved 0 System Disapprov::}d ~eeds Correction
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COMMENTS. "'" $j'$,.... ,---I!.~ " ~1w"l. lOr #.. t?It,.h7f ~. ~ .....~7"'~
..10.. '''0+ _.t Ii. r.rl....~ eo.'J.f nl'~':".~ t1.f:.~I.;. !l0 A-ad,'J-,."y or I\II-U""DM to i/.~
e",sf,'-. .s~r...cl..l~ wln.J.e d....I,Lo,,~.~ 0)(/1,....+ a.JJ;~,' ~o 0""..1 -IJr~..A,".
· Signature:~ Date:.:S-.v.,,71l
'FOR INSTALLER'S USE: Trench Depth "", -/ Fill'er De~th Below Tile" -/6 -
Tank Capacity 1/h715 _ Manufacturer E'(/6-J:r~}J-<A/V,l}
Measured distance to well from tank.....i:""/1 - from draiA1ield~;
-J, O-I.J.~.. ...H.... 160 ~ u}n/8 >p/) ".': 01' (I ~
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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-"
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Please complete all lines inside white boxes, if possible.
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OWNERS ADDRESS (II not ..me .. above)
ZIP
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MAP, PARCEL NUMBER
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SEPTIC INSTAllED
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land Management Dlv. staff can
not be held responsible for
evaluations or recommendations
based on false, Inaccurate or
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W: 3 L~NE COUNTY DEPT ENV MGT RECEIPT ~ 317691 DATE 101691
. APPLICANT TAYLOR, VIRGIL ADDR 210 DORRIS ST., SPRINGFIELD, OREGO~
TL~ 8030220001700 SUBDIV LOT BLK
NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES IBLDGS .01 PHONE 747 1098
OWNER NME TAYLOR, VIRGIL ADDR 210 DORRIS ST.. SPRINGFIELD. OREGO~
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FE€ DA~S
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W: 3 LANE COUNTY DEPT ENV MGT RECEIPT I 317691 DATE 101691
. ,!\PPL.ICANT TAYLOR, VIRGIL ADDo: 210 DCif(RIS S1"., SPRINGFIEL.D., OREGOt.
TL.I 8030220001700 SUBDIV LOT BL.K
NEW BLDG TYPE USE R 0DRMS 0 UNITS 001 STORIES 10LDGS 001 PHONE 747 1098
. OWNEI:( NME TfWLm;;, VIf(GH. (,lH'f! 21<1 DORfnS ST., SPfCl:NGFIELD, rH(EGClre
CODE APPL. NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DArS
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