HomeMy WebLinkAboutPermit Septic Tank 1991-1-21
.: .... "'"
PERMIT #
d3/-q;
~ '
REQUEST
FOR: SEPTIC /.c., M
. ...~
-~-- ;
RANGE
SECnON
':n
11. SECnON
TAX LOT
SUBDIVISION I PARnnON
LOT I PARCEL ILOCK
...~
'li
, TOWNSHIP
1"7 rn
LOCATION ADDRESS
1 Lt
?OO
f17? .2'.noprRfln In..
STRUCTURES NOW ON PROPERTY
srr;ncr.Ue1d. OR
97477
QFD. ~~rt1. G~r~r~
PR5PllSEO USE SEPTIC: INBTALLl!O
R yes
DESCAl P110N OF PROPOSED WORK
WATER INSTALLED
NO, Of' STORIES
NO. Of' EMPLOYEES
CON8TRUC~ COSTIVAWE
NO. Of' IEDROOII8
REPAIR SEPTIC SYSTEM
DIRECTIONS TO BITE FROM COURTHOUSE
rpntpnn; rll nvpr T -S = S nn Annprsnn T,n = at end of blaclctoD on riaht.
APPLICANT NAME . ADDRESS
PHON E
Elfllne P0.(lJJ:;~
OWNERS NAME. ADDRESS
Same
CONTRACTOR NAME
(site addr)
726-2870
PHONE
OSR LICENSE'
PHONE
) MAIL PERMIT TO:
Elaine Poole
) NAM E
I have carefully read
Elaine Poole
~ PRINT NAME
(
(site addr)
)
FEES DUE: $
~
ADDRESS
BOTH sides of thIs appllcatl~anshhere~y ce~ttR\ all Information Is true and correct
..,(. t::... ~\_ro ,/:, r ("7-t"~-L . 1- ;2 7 -9 /
SlgnBfIJf'- -- . - DATE
{I
APPROVED BY:
~ ~..J-
DATE
/ - J- 7 ~ '1/
, ,/
CALL FOR INSPECTIONS (SEE BACK OF FORM FOIr INSTRUCTIONS) 687.4065
SEPTIC permits are good for one year. ALL other permits expire after 180 days unless inspections are current.
, ,
VIOLA nONS
SBTBACKS AND OTHER ~v"u.. ,ONS OF APPROVAL MUST BE S11UCIL Y OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF nus PERMIT.
CITATIONS MAY BE ISSUED UNDER TIlE PROVISIONS OF LANE COUNTY'S INFRAcnON ORDINANCE AND/OR OTHER REMEDIES AlLOWED BY LAW.
A MINIMUM OF AT LEAST 24 HOURS ADVANCE NOTICE MUST BE GIVEN FOR INSPECTION REQUESTS
Have the following information 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 OFFICIAL RIGHT TO TRESPASS ON PRIVATE PROPERTY ORS 215.080
POWER TO ENTER UPON LAND. TIlE COMMISSION, AND ANY OF ITS MEMBERS, v,.,..~ AND EMPLOYES, IN TIlE PERFORMANCE OF 11lIlIR FUNcnoNS, MAY
ENTER UPON ANY LAND AND MAKE EXAMINATIONS AND SURVEYS AND PLACE AND MAINTAIN TIlE NECESSARY MONUMENTS AND MARKERS 11iERIlON.
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place,
UNDERGROUND t'll'lNG 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 equipment, 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, fIre 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 "t't..v led.
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 iIlspections have been made. and ap1-'<V ..ed.
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 fInish 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 "t't'.v/ed 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 recommended 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 "t't',v..al 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 THE JOB SITE AT ALL TIMES.DURING WORKING HOURS.
TIllS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WlTIIIN 180 DAYS, OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOc::;A nON MA ~OCCUR IF THIS. PERMIT WAS ISSU~D ON THE BASIS 9I:,INCOMPLETE OR ERRO~OUS INFORMA nON.
~ - ,I"':"
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 THIS 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 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 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 & AL TERNA TIVE SEW AGE DISPOSAL SYSTEMS:
When subsurface construction is complete, the permit holder shall notify the County Land Management Division by submitting the installation record
form. 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 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 property lines 10'
Edge of road right-of-way 10'
Building foundation 5'
Wells or other water sources 50'
DRAINFIELD
10'
10'
10'
100'
tJ ;/
I .
B/I c/ rlo :,. '.'
, 7;l. ;1r~d eA'
r-
,;<:--frJ
(",)?'l~
, ;/...0 I (,,t
. t 1 r/ ~I
C-f..\ )
>,
,
" ,~';
j,~, -.... La-V'> (....-
I
I
I
L
1--',' ...
'J..,' 0\ ul\l~ t
'.. ,\ '1 . 'I :
. 'f)))( == _I 1-1_1
t,': t,:
'f. 1$ 1- In!!
~
)<"1 '
p. '1,1.;1' I
-:;2i\\r,~ " ~6€c.i
. ~\... ;A)(~ 0.-
~,\, \0 h .\\; ,,'^,
1,1' 'o.ll,~ .,J"s,'-
, '
,_., ___._..____'I.__..:..._~,~---~_._....
.
. I'
. \ If" '\
e.-J. ' t:' l
. r ~I'.Ii"
r;
t;(~)ttt \,
--T" ..
,)
~,
,
"". - ...-----.-- Y. ....____..__ ...-...---
o
:. ..1-_..:..
. . !
, i 11
: !i
LI\JJ
~~i-'
.,
,
\
t-
o r/1 e,
\... \" () \
I . e..
6f lY0
~ \,,j\'
'*
,-
,\ f\ ,.1-
).~\:..,' 1) {'~,.
0...0 '0'" ~
.,~
.,.l.,-
'I'
\b-.(Q./
(:-.
i i I
~ I !
i .11 ~ .! I '
, i; . .
=:-_ --L...""': 1--'- ! I
-r ~ :--;-t- ~----= t
t i. ! I
i ~ '
-~~-T~~ .-- '-~-- ._-.-_.....
;f\ """. ,,(
o 1 I
. . (,I;,.
(;)" I.J IV'O; (1'1l .1:
_" .:" \ 11'.('
, V'h oC ,'--
..~ (t \... (' (fJ-
. ~rt . ~/-- ')
("~~ t. \
'~\(I c.. ,'~ ':)
./l' "'~ o.
r, tJrf .
q.
r
-.(5<-,)1
'V'\
\ \~ 1.',))
o ~) ,.F'" ~
\(0\ ' cY.
\ 11'i?
(p,\Q;{ . '
/" 1"', -1 . '
\ .~\ ,'/
I (,{'r,~lt: ,.
/,. .
\
I
\
. \
I' '
i / \,
V"c/ ~
0+
.. ~.
l
.~ r~::-""
LH__.'..
f) ie, J.
c '
)C<J .!.
e,'\. \.;.-.;'\.~
ci ( ,', .,
~. ,
,~ ~' \:,. \
1
..
I .-
-..-7
f:,;; '-{" ,P L
( 10 To P. L
! . I
/<'
: ! ~,),
~< .
,. .
...--.. .
,.
Please complete all lines inside white boxes, if possible.
[;; C{ , 'Vd? ~g I c:::
"OUH N~MI:
b )7..2-- A-nd o~~..-fh.. L-.M}1 ~,
YOUH AUUHESS
S..LI r1'jA qS?1'e~d c/O f(
CITY '" <J ' -
~~
1~-27~q I
UAlto
.7U-ZP?O
PHONE
9?V77
ZIP
OWNER OF PROPERTY (if not same as above)
PHONE
OWNERS ADDRESS (if not same as above)
<,p/+
CUNIHAl;IUH
ZIP
License "
,.
MAP, PARCEL NUMBER
(Found on tax maps In the Assessment & Taxation DepL)
/7 03 33 r/.~. LDB
Township Hange Section 1/4 Section Tax Lot
Township Range Section 1/4 Section
Tax Lot
"
lownshlp Hange Section 1/4 Section
I ax Lot
"
;
SITE ADDRESS
n c:P j)", ~ c:. <:
Q 0 O. V .€...-
,
,.
MAIL PERMIT TO:
~~P'
~ t'?,n~C!~
V .
NAME
AUUHESS
CIlY
ZIP
"
,..
land Management Div. staff can
not be held responsible for
evaluations or recommendations
based on false, inaccurate or
Incomplete Information
~
Existing Buildings or
Improvements on
Property
I -, House
CE-Barn
a3Garage
~ Mobile. Home
~ Shed
SEPTIC INSTALLED
U:::J Yes
~No
Water District
::,~
~
,I
Directions to site
from Courthouse
(' p '. -I f' ~\ "', 'ct ( t'J1J' f? .~
...,...., _s 1 ~CJ..... f--t~ -8v\.
~1 () I.,S~L-...O fA. Q.. )
.J p ~ ~ fl- ILia ( Is:..-
~oy '-)l'l n fsJJ
~Jr P L~; &,,-1, C
z, r ,,' i-s )
J
ZIP
,
Mobile HomV \.
Pia ent Only
Bran
Year ~
Size /' "'"
~Of lip-outs "-
No. of BedrmC' ...........
License # "
~ ~
)
~ n ~
~III
~~
*1
i
I
L I: I I.
nllh
~
,
~ I , J;
\ I \; i:
r i 't . L(:lNE
. APPLICANT POOLE, ELAINE
'rl..~ 1703331400200 SlJBDIV
NEW BLDG TYPE USE R BDRMS 0
OWNER NME POOLE, ELAINE .
CODE APPL NO ACTION DESCRIPTION"
DP
DP
i:31."
COUNTY DEPT ENV MGT RECEIPT 4.231.91 DATE ~1?R91,:'
j::iDDF: 672 (lNDEF;:S'Or). Li\1 ,., SPR I HGF I ELD .. .....n 'I'! '\',
,Lo'r BLK
UNITS 001 STORIES 4BLDGS 001 PHONE 726 ?R701
ADDR 672 ANDERSON LN., SPRINGFIELD
SQ FT UNIT COST VALUATION FEE
;,
:0(,\' 'n
If,
"11
f:' f'
BI:1
;::- [: J<
SWR: FT. WTR:
j.,ECHt,r'.,! I C: (:1 L FEE
STtlTE SUF;:CHtlF:GE
PLt,i'--l CHECl< FEE
F.r ,. F: i~ I j'..j :
FT
II.!. i'
" '\' 'I.
.
~ ~ ~.f~L ;;:;FI)</E:':~ITH:
('"iECH
SUF<
I
~:; ~~.:
::?~:) I:;
SDS LC 23191 SDSR
SDEQ FEE
'l~::;..\ (J()
~) ... (-) (:)
CDr'iPLET I CJN Dt.irE
DEPOSI.r
,!(..j( I
E: (.) ... (.) (.) c:: 1<
.:
g
,;
1"-
,
,
.n !
L:(.~I It:, :
SJE:G~i...i :
PL!'--!
, t.< ~:'i
S'DST
roo { j"OO
r.:.f...i::.
F'C:!<
I I~';~ ::~.:
. ./
.;., ]'
:.,' ..
(] TF;~
T(.:ll{EN :(-:lY' Ill!.
I
Es'r ,",
::?
I i,\.! I
I ~ !~ ~
.
~
, ) I l
I. '1 n 1.
. ~
. 1..
"....
-''''\ .
.'
.'
II~YK
H.U "..~
t<\rw.
u\nll
.':,\"
\
,. -
~IM IjU
u [j'J II
.il'~M JJ
'- ~ ,I"(J
:--. ___:';._._"'_:::'_~'_~_'_ '_..:_.,;_..~_~_._---;,_:_--l_:-:_""_~'_..__,~_._,_, _ _~_;~_~_ _'_
~ ~J.l t I'" ,.." ]. -, ,.. "J ...'.... ... r I I'..
H" .. I,.. .1....'..'1.. I 1" UJ... ::...
TLI 1703331400200
NEt.j BLDG TYPE
Oi.Jt'~[F:
CODE
. ,BP
{iP
BF'
BP
IW - ,
NME POOLE, ELAINE
APPL NO ACTION DESCRIPTION
L (~\"'! E CD U i'~ T Y DE F' TEN V j"i G T r~ E eEl F'.r :g: ;? 3 1 9 .j D l'~ T E 0 'i ;.:,~ D ';~j!.ll.l ~
E!...t~ I i'~E i~DDI:~ 67:2 (.~INDEF;:SDN LN ,.. SPF: I NGF I ELD ~ tI u ^'
SUBDIV LOT BLK
USE R BDRMS 0 UNITS 001 .STORIES IBLDGS 001 PHONE 726 2870
ADDR.672 ANDERSON LN., SPRINGFIELD
SQ FT UNIT COST VALUATION FEE
Dr-,y;..
lJ\lU!ftL :i;:FIX/B?'ITH:
lJ',n"l.........,
[vI ::.1..,1"1
Sl...lr~
PCi<
SWR: FT. WTR:
HECHr;NICAL FEE
,ST~'tTE StJI:~CHFlr~GE:
f'I...r-IN .. CHECi( FfE
FT . f~('~IN:
FT
u~t\g
11U ~ f/
:::; :1~
~.:,~ ~::; ~{
SDS' LC~. ::!:5'i 'I'i SDSf:;~
; S;,:OEC~ FEE
7~}. 00
5 ,. (.) ()
C~:lTG :
PI..,j\j
F:tl
S'I)S'
ELE
peK
ISS'
. ~!.
i/
,,,,,t'
I~' .I,
.CiTF;:
t~~ 1:: (~lJ :
6
rtil<EN B\' :€if!.
EST. COMPLEtION DATE
:0 E F'O SIT :u:.,p:.
l30,.OO CK
!I~MU
B.drJ
r"U it i{
-.: &1:1 t