HomeMy WebLinkAboutPermit Building 1992-8-24
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PERMIT ~ /9 C}
d 77 - / Z
REQUEST
FOR:
INSTALL SEPTIC SYSTEM
. TOWNSHIP 18 RANGE 02
SECTION
05. '2:;'''''
YOU: I.OT 201 _UIIDlVISION 'PAJlTlTl,*
LOT f PMCiL al.OCK
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TIiCAnoN'CfYlq FILBERT LANE, SPRINGFIELD, OREGON
STRUCTUREi' HoJW VH PRbPERTT
EXISTING AG BUILDING
PROPOSED USE 8EP11C INBTALLEt)
PRIVATE USE
WATER INSTALLED
lIIU.ur~.U...~
...::.. ;:,... .;wPLOYlEI
CONBTAUCT1ON COSTIVAwa
DESCRIPTION OF ,""OPOSED WORK NO. OF BGiJlOOMB
INSTALL SEPTIC SYSTEM
"1i~NND TOtx'IT: coR~i.~~~\ TO J A~-;~~--;;OAD, RIGHT TO F I LBE RT LAN E, RIGHT ON F I LBER
LANE TO SITE ABOVE.
"ppueANT NAME. ACDRESS
RAYMOND C. JACKSON, 43081 DEERHORN ROAD, SPRINGFIELD, OREGON
'"O"E
896-0143
OWNEIlIlo ........E . ADDREa8
SAME AS THE ABOVE
PHON.
SAME
CONTRACTOR NAME OS" UCEHBt:. PHONE
BOB STORRS
~ MAIL PERMIT TO: )
RAYMND C. JACKSON, P.O. BOl( 297, tIALTERVILLE, OREGON 97489
'l NAME ADDRESS
· I hava carefully read BOTH sides of this ap~1 tl ~~rtlfy tflIat al~nformatlon Is tru~nd cjlrrect
RAYt-lOND C. JACKSON If. C.vrCVCl7~ d' l<f /YZ-
. DRNT"'~\'. .~ 17 DATE - I
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u~ READ CAREFULL VI Your Authorization Is Based On The Following Conditions ~
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FEES DUE:
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APPROVED BY:
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DA TE J~ ~-t/ 4' !!_
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CALL FOR /NSPECTIONS (SEE BACK OF FORM FOR MSTRUCTIONSj 687-4065
SEPTIC permits are good for one year, ALL other permits expire efter 180 days unless Inspect/ons are current.
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VIOLATIONS
SETBACKS AND onmR ~........~.,J OF APPROVAl. MUST SB S11UC'I1.. Y OBSERVED. VIOLATION CAN RESULT IN REVOCATION OPlHIS PERMrT.
CITATIONS MAY DB ISSUED UNDER nIB PROVISIONS OF LANE COUNTY'S INFRAcnoN ORDINANCl. AND/OR OTHER REMEDIES AlLOWED BY LAW.
A MINIMUM OF AT LEAST 24 HOURS ADY ANCE NOTICE MUST BE GIVEN FOR INSPECl10N 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
PUBLlCOWICIAL RIGIITTO TIlESPASS ON PJUVATE PROPERTY ORS ns.oao
POWER TO BNmR UPON L.U.'D. nm COMMISSION, AND ANY OF ITS MEMBERS, OFFICBRS AND EMPLOYBS, IN nm PBRPORMANCB OF nmJR PUNC110NS, MAY
ENTER UPON ANY LAND AND MAKE EXAMINATIONS AND SURVEYS AND PLAC! AND MAINTAIN TIm NECESSARY MONUMBNTS AND MARKERS THEREON.
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND PIPING INSPECTION: To be made after all underground piping has been installed, prior to any backfill.
CONCRETE SLAB OR UNDER-FLOOR INSPECTION: To be made after all in-slab or under-floor building service equipmen~ conduit, 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 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, fife 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 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 board joints and fasteners are taped and fmished,
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 INSPECTION: To be made just prior to the structure or remodeled area being occupied and prior to operating any equipment
FINAL PLUMBING INSPECTION: To be made just prior to the building, structure or remodeled area being occupied.
FINAL BUILDING INSPECTION: To be made after fmish grading and the building, structure or remodeled area is completed and ready for occupancy,
MOBILE/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 plumbing connections.
Footings and piers to comply with State foundation requirements for mobile homes or as reconunended by the manufacturer.
Minimum finished 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 WORKlNG HOURS,
TInS PERMIT WIlL EXPIRE IF WORK DOES NOT BEGIN W1TIl1N t80 DAYS, OR IF WORK IS STOPPED 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 THE POINT OF REQUIRED INSPECTIONS WILL DO SO AT THEIR OWN RISK.
Your signature on the front of this form verifies the following: I HA VE 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
further certify that any and all work perfonned 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 property. 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 sllbmitting 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 me permit
holder. If construction does 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 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 t'.~t'......) lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAlNFIELD
10'
10'
10'
100'
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PLOT PLAN APPROVED
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prlor to starlin:: constructlon.
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'SEWAGE DISPOSAL SITE EVALUATION
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Job Location
Written Directions
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S)rii~:7:'fisl;:.";, tJ3:. 9747(:'
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Subdivision:
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Block
WATER SUPPLY
APPLICANT'S NAME AND ADDRESS :c:....,.:"-:.. ;... :<illc,,:i;L::;-
OWNER'SNAMEANDADDRESS ;,.a'J Jo::>:so,; ? 0, ~"....
STRUCTURES NOW ON THE PROPERTY
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_Phone .i./..':;':;~ lt~-
.Phone 3l.!.4-.:.274
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Wnlt~rville, a~ 97476
. PROPOSED USE OF PROPERTY
J hereby CMlfy that the above statements are true end accurate, and Ihat I have the tolJowing legal Inlerest in the property: _owner 01 record: ""ntrect purchaser: -potential buyer:
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_realtor or agenl.l tUrlhe)' ~ thatfd not the o/,er) I am authorized 10 acI for the owner of record, and that said own~~ is a~are ~ approves~; this actio:", ;'. '~ ., ~
TEST HOLES READY. .'?~ 1\ OU) Signalure)(tr::., v> (o,h",,_ i ;~: I ~:;..;: " i....: ':"';'7'!:flate 1 v I L o/~ C;
........".........................".............. "'.... ........................... OFFICE USE ONLY BELOW THIS LINE."'. ................. ......o..... ... .... .............
SITE MEETS STATE STANDARDS
Standard System
Sand Filter
1 Foot Capping Fill
YES NO YES NO ,
~ 0 low Pressure Distribution 0 0
0 [j Holding Tank 0 0
0 0 Other 0 0
LAND USE COMPLIANCE
Zoning) J (~r;J<,~r:. Acraage or LeI Siz_
(TOTAl)
) Completed
) Pending
Partitioning If
Parcel If
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COMMENTS:
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FLOODPLAIN INFORMATION
[j Approximate
Study Area
All or pan of this Srt9 may be in 8 flood hazard
srea for which 100 year flood lev~s have not
been established. Extra precautions may be
appropriate to assure thai the building site will
be reasonably safe from flooding.
Allor pan of thIs site may be in 8 flOOd hazard
area for which 100 year flood levels have been
established. A buik:ling elevation above the 100
year flood level may be required.
All or part of this site may be in a flOOd hazard
area In which 8 fJoodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative effect of
proposed c..., ...............m 'Nill not Increase the
100 year flood level at any point.
o Detailed
Study Area
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT, ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT
ARE AT YOUR OWN RISK, IF SITE IS APPROVED, SEE REVERSE SIDE.
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AUTHORIZED SIGNATURE' DATE .
..ANE COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8JH AVENUE, EUGENE. OREGON 97401 (6L7-4051)
C Floodway
;55-32
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.' For Mobile Home
Placement Only
Brand
Vear
Size
No. of Bedrms
License ;III
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Plea e complete all lines Inside white
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boxes, If possible.
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ZIP
OWNER OF PROPERTY (If not _. as abov.)
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OWNERS ADDRESS (It not ..me .. a&loft)
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MAP, PARCEL NUMBER
(Fo.." on ,.. m... In ,.. ~~Z: T...Uon D.,L)
I!;- 02. . (),~:;~ 2/3 20 I
IOW,..hlp "'1Iinii"" _non 1 n - lax LOI
TOWnMlp ""R;i;OI Section 1/4 SecUon Tax Lot
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MA~I. ERMIT TO: .
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Existing Buildings or
Improvements on
Property
c::l House
Ii!!laBam
c::l Garage
c::l Mobile, Home
c::l Shed
SEPTIC INSTAlLED
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E3-No 'SZ:8'1'~ ex'?....
Waler District ~t/9/i'!
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., Directions to site from
::>.;: nearest msln Intersection
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Land Management Dlv, staff can
not be held responsible for
evaluations or recommendations
besed on false, Inaccurate or
lJIl".- ..., Incomplete Information
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"14-68 02/92
Water
SewerlSeplic
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MECHANICAL FEE
STATE SURCHARGE
PLAN CHECK FEE
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~~P~ICANT JACKSON. RAYMb~~E COUNTY D~G~RE.~0a~TD~f~~~R~ ~B.~7i~~iNG~tl~D?8~~9~
TL~ 1802052300201 SUBDIV LOT BLI<.
NEW BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES ~BLDGS 001 PHONE 896 0143
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OWNER NME JACKSON, RAYMOND ADDR 43081 DEERHORN RD., SPRINGFIELD, 8R"
CODE APPL NO ACTION DESCRIPTION SQFT UNIT COST VALUATION FEE .~
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EST. COMPLETION DATE
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RAIN:
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DEPOSIT **
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9 c MUST..>>E IN BLACK INK 12,m C~"
Permit No. 2.. 7 <{ ,- / 7- Twnshp. rr Range C"I L Section!J..\. 2 , 7 Tax Lot L.l1 ,
Standard System p(Alternative System 0 (fuwCi!y..;r'ype)_~. ~ - r _hi
Job Location (Street Address) ~/U~~_. ~#;.t7A...I/J'
Supdivision/Partition ". . 'Pa:rcel. ot /._ Block
DETAIL SYSTEM PLOT PLAN AS CONSTRUCTED
Scale ( = .~O
I have personally inspected
the system shown hereon and
certify that it ass been contt-
ructed in full compliance with
the provisions ~~R 340 DIV 71
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USE BLACK INK ONLY / "
FOR INSTALLER'S USE: \ Trench Depth ':J '1 (I Gravel Depth Below Tile b
Tank Capacity \000 '1'" Manufacturer l. ,,\ \<~ "'" c ,'" .. G ~"'-... '" .\,.",~..
Measured Distance from Well to Tank - From Drainfield - TotaA..ength of Lines ;;1,4 d. '
COMPLETE THE FOLLOWING IF A PUMP WAS USED ON THIS INSTALLATION:
I (installer's name) certify that a (Mfg.) . (Model No.) Pump
and Mercury Float Switch (Mfg. and No.) have been installed with this sewage installation.
Signaturp Date
FOR SANITARIAN'
COMMENTS:
USE ONLY: p( Sy ,tem APP~~~.L 0 ~a~~ved ~o Ne,e,~~~:
'AAAIhA ~c# .I?~AII~ .
LJ System orrected Dat..
;r.ro _ gaUday Signature ~ -& _ Date -Lt?-~9~~
System Capacity
INSTALLATION RECORD & CERTIFICATE OF SATISFACTORY COMPLETION When sig d by the County Sanitarian, this certificate is evi.
dence as per ORS 454.665 of salisfactory completion of a subsurface sewage disposal system at the above location.
To request inspection. return all three (3) copies of this form to: Lane County Environmental Health Services', located in the basement of the
Public Service Building. 125 E. 8th Avenue, Eugene, OR 97401.