HomeMy WebLinkAboutPermit Septic Tank 1991-5-22
P/91~r-9/
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~ REQUEST
FOR:
SEPTIC SYSTEM VERIFICATION
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I TOWNSHJP 17 RANGE 03 SECTION 23. 13s:CftON TAX LOT 81 00 SUBDIVISION / PARTiTION
L05Tlf~ ADBRLSA ~Vto N EST R E E T, S P R I N G FIE L D, 0 REG 0 N 97 Ll7 7
4-
STRUCTURES NOW ON PROPERTY
EXISTING SINGLE FAMILY DWELLING, GARAGE, SHED
LOT / PARCEL BLOCK
PROPOSED USE
SEPTiC INSTALLED
WATER INSTALLED
NO. Of' STORIES
NO. Of' DlPLOYEES
CONSTRUCTION COSTNALUE
PRIVATE USE
DESCRIPTION OF PROPOSED WORK
NO. Of' IlEDROOIIS
SEPTIC SYSTEM VERIFICATION
DIRECTIONS TO SITE FROM COURTHOUSE
1-105 EAST TO HQH STREET EXIT, HQH STREET TO NORTH 5TH STREET, LEFT ON 5TH
TO BLACKSTONE
APPLICANT NAME" ADDRESS
SAME AS THE ABOVE
CONTRACTOR NAME
OSR LICENSE'
NA
PHONE 746-9804
PHONE
SM1E
PHONE
NA
(J
Information Is true and correct ~
DATE
.., ~.
RANDY HUNTOON, SAME AS THE JOB ADDRESS ABOVE
OWNERS NAME" ADDRESS
NA
~ MAIL PERMIT TO:
MAIL PERMIT TO THE OWNER AT THE JOB
~ NAME ADDRESS
I have carefully read BOTH
RANDY HUNTOON
ADDRESS ABOVE
~ PRINT NAME
sides of this a~a ..,/..1 -ltereby certify that all
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FEES DUE: $
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CALL FOR INSPECTIONS (SEE BACK OF FORM FdI( INSTRUCTIONS) 687-4065 J
~ SEPTIC permits are good for one year. ALL other permits expire after 180 days unless inspections are current.
APPROVED BY: .J:,/';7 _~
DATE
S-L2--'1 J
~
VIOLA nONS
SETBACKS AND OTHER '"u,......"ONS OF APPROV AI.. MUST BB SllUCIL Y OBSERVED. VIOLATION CAN RESULT IN REVOCATION OF nns PERMIT.
CITATIONS MAY BE ISSUED UNDER TIlE PROVISIONS OF LANE COUNTY'S 1NFRACJ10N ORDINANCB AND/OR OTHER REMEDIBS AILOWED 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
Pennit number -' Job address - Type of inspection required When it will be ready
Your name and phQne number - Any special directions to the site
PUBLIC OFFICIAL RIGlIT TO TRESPASS ON PRIVATE PROPERTY ORS 215.080
POWER TO BNTER UPON LAND. TIlE COMMISSION, AND ANY OF ITS MEMBERS, OFFICERS AND EMPLOYES, IN TIlE PERFORMANCB OF 1lIBIR PUNCJ10NS, MAY
"-"''''''- UPON ANY LAND AND MAKBBXAMINATIONS AND SURVEYS AND PLACB AND MAINTAIN TIlE NECESSARY MONUMENTS AND MARKERS THF.RBON.
REQUIRED INSPECTIONS
FOUNDATION INSPECTION: To be made after excavations for footings are complete and any required reinforcing steel is in place.
UNDERGROUND 1'll'1l~G 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-floer 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 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 fInish grading and the building, structuIe or remodeled area is completed and ready for occupancy.
MOBILE/MANUFACTURED HOMES: An inspection is required after the mobile home is connected to an "l-'l-'W"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 fmished floor elevation shall be certified when required by Floodplain Management
Tiedowns, if required, shall be installed and ready for inspectio~ within 30 days after occupancy. Tiedowns shall be install~ per en:losure.
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 THE JOB SITE AT ALL TIMES DURlNG WORKING HOURS.
TIIIS PERMIT WILL EXPIRE IF WORK DOES NOT BEGIN WITIDN 180 DAYS. OR IF WORK IS STOPPED OR ABANDONED FOR MORE THAN 180 DAYS.
SUSPENSION OR REVOCATION MAY OCCUR.;rp THIS PE~ WAS ISSUED ON THE BASIS OF INCOMPLETE OR ERRONEOUS INFORMATION.
ANYONE PROCEEDING P A~T 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 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 & 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
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 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 ofORS 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'
DRAlNFlELD
10'
10'
10'
100'
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i Please complete all lines inside white boxes, if possible.
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ZIP
OWNER OF PROPERTY (il not same as above)
PHON!;
OWNERS ADDRESS (il not same as above)
ZIP
CONIHAC10R
License #I
MAP, PARCEL NUMBER
. (Found on tax maps In the AS$Ossment & Taxation DepL)
;-76J3 6.Yt3r V 'k-/(jO
t)' O~ShIP Hange Section 1/4 Section --'rixlot
Township Range Section 1/4 Section Tax Lol
lownShlp Hange ::teetlon 1/4 Section lax Lot
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~ SITE ADDRESS .3 LIO<.
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Existing Buildings or
Improvements on
Property
Ie House
c:J Barn
/.eJ Garage
CJ Mobile. Home
li!IJ Shed
SEPTIC INSTALLED
!elVes
CJNo
Water District
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Directions to site
--fr-o..~ ~"lt!':the1:/t;9
.T -105 &:asf +D q
-Street- EXI f, /tL/<e Q
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On Ai I 5+ h fv 13/(}'(!ksfon e,
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ZIP
Land Management Div. staff can
not be held responsible for
evaluations or recommendations
based on false, Inaccurate or
Incomplete Information
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For~.le HomV
Placeme Only
Brand
Year X
Size./'" '""'-
~f Tip-outs '""'-
~ No. of Bedrms " "-
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