HomeMy WebLinkAboutSpecial Inspection Building 1974-1-22
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REQUEST FOR S IrE I NSPECT 10K
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Use O.nly .
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Code
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C.T. Number Special Permit Area
Yes No}
Urbanizina Area -,'\
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT.
PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK.
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If Subdivision - Name: 1-- a L~I7:4'" 1; &",-,t~AA-"",J7(J.r/~_# b
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/7 {).J W iJl?-..,"tue./ C~sI.:Cd Yes)O No
Township Range Section Tax Lot No. Owner of Property Owner's Co~sent
?Ja.st;t/.bv' c:::o.....:/te<:/i;,;.:~ ~ No. of Sites / $ /5" 00
Name .
';;'~' i.,fe 3 Y 1114,tk No. of Acres $
Mai I ing Address ~ .
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7'1 7-4 ? 7/, .X /!T~.~:" &c../~.:"'"'" ~~f';{? Check
Telephone #S i gnature of App I icant .Dat"e'/"""d .'
$
K.oo
Owner
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Seller
Proposed Use '/ r / Afpp I icant' s I nterev Buyer
of proper~~: ')"'';t'I.e- f7l."i-t~ .a~~'i~perty: Other (Specify):
tB-i -~2- C&'4.t~kvv sr 4J(j.""..e-
Property Size Legal Access'- Road Name Existing ~tructures on Property
Realtor
Is Property Within One Mile of C,.jty?
Yes y What City? ?.Pv"'.....y.J~
N ; v
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Proposed Water Supply
Publ ic V District:
Sp ring' We II
8'k igJ
Other (Specify):
Property Location (Directions):
When Will Test Holes Be Ready?
MARK TEST HOLES WITH OUR FLAGS '
II ~)..-/7 ~
. (Date)
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c.. Ov to v..:.:J.
5~
Location of Test Holes on Property~
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Draw diagram of property showing location of any landmarks and relationship of test holes to
these landmarks: '-'
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MAKE CHECK PAYABLE TO: HEALTH AND SANIT~TION
MAIL TO: LANE COUNTY BUILDING AND SANITATION DIVISION, 135 E. 6 th Ave., Eugene, Oregon 97401
C55-55
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APPROVED
V'
NOT APPROVED
REASON FOR NON-APPROVAL
STATUTORY AUTHORITY
ORS 431.130 and 447.020
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pit> + pi ct'^- ~V\J:J 11'\: JeJ w~~
rb-..spec+/~--- ;<:;; u.\^.'{'e.J\'st,'c-,onci
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OAR 41-020 Par. I
Insuffici~nt lot size for
(~ individual sewage disposal and
~ I Ie water supply.
OAR 41-030 Par. I
A'e-~ Heavy imperv ious non-
absorptive soil.
OAR 41-020 Par. I ,
Water Table above minimum.
state standards.
Ot he r
Engineered Site Modification Feasibility:
Possible
Not Recommended
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( \'\,~Authorized Signaturli! .
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FIELD INSPECTION SHEET
Completed By Sanitarian
Location:
sect.?-t./ T. /1 R.O :5Tax Lot or Acct. No.
Are public sewers available or nearby? (Distance)
Are'there zoning or environmental considerations?
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Size of property:
Are other systems in area malfunctioning? ~ h
Is there room for future expansion?
PHI
(-R/Dt
Surface feature considerations: (Explain)
Slope: e>
Flood plain:
Plants:
Rocks:
Low area:
Drainage way:
Streams:
Water suppl~ and utili ties h c 'b I I 0 0 _I
Conunun~ ty water: I\""' Cl \ V'-' 'OLu 1\1 /5"/.
Private water: Location:
Water lines:
Gas lines:
Wells on adjacent properties:
TEST HOLE RESULTS
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#1 Test Hole I : #2 Test Hole
0" -rd/ 5"4hcj- ioco-;. 0" -6(: 5'7/>41 oa~,: 0"
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Soil Classification (If Known) :
Is curtain drain required?
REMARKS: (JJ ~+e.r i--Otlu/-e
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Interim Form #6
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Permit #- "7 '(-/0
1- f).1). - 7 L(
LDt 6
0(,A ) c(Oz bk
#3 Test Hole
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PRO.. L BSURFACE SEWAGE DISPOSAL ~Eh
Ins er: Complete top part of fo~
signature and submit both copies with
application.
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.2/iJp~,
Instal}er's Name
bJ.~r;v~ ~ r"V~Crf:..""l e.c"
No. Living units Bedrooms
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Septic Tank:
Ft. ,from well
Inside Dimensions:
Length Width
Applicant
Name
Mailing
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Steel
Ft.
Diameter
(Exhibi t No. I)
I Property Address
Lv'l (, 13 j"v/t ' :1
Baths Basement
Yes_ NoL
Permit No.
1 ~ q-LcIt~' 1; e.-'/;'v/''uoY
Water Supply
Community, Public ~ Other-List
2-
Concrete XJ
No. Compartments
Gal. Capacity .1 c?J~ 0
'Tile Disposal Field:
Distribution Box: Yes _ No_
Other Distribution - Type
Depth
t) -i?~t:~
e-.. .'f f t.4-,._-'h"'..... e. ,r
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Feet from
Well
Lot Line
:Front ((;, Side'~ Rear 10
Ft. betweenFilter'. ~'lter.'6ePth Filter'D-ePth
I ' -- '21 . i( ove "" i be ow . .
1nes;, Type -?'f .Ie" n. tl. e 6 1n.
Foundation /0
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21 [j 1. i "h1c. i ""
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Address 5" ,J; a
,All:':-~:' .., "'.~, r~.. " ...' .
Length of Lines' - Ftf Trench Total sq.
1. fli 2.~.r 3 .~{ 4.~' 5 .i>( 6. s-< Width 2.. ft.
Plot PI, a.n (~ee instructions): ,
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Signature
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For Sanitarian Use Only:
CJ Approved: System Installation Conforms to DEQ Rules for Subsurface Sewage Disposal
o Disapproved: Does not Conform to DEQ Rules for Subsurface Sewage Disposal
Date:
Remarks:
State of Oregon
Department of Environmental Quality
Sanitarian's Siqnatur.e
t ..~-im Form #2
.
BUlLDI~G' SiTE EVALUATION
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JYCHo
, ) Bu i I ding Permit App I i cat ion No.
.!>K Site Inspect ion 7 '/-'/6
( ) Pre-Pe rm i t Investigation
LANE COUNTY PLANNING DEPARTMENT
NOT
app I icab I e
I. Zoning Ordinance Compliance ( )..
(Zone rR _ ~ )
2. Subdivision Ordinance Compfiance ()
3. Requ i red Access ( )
4. Building Site (Area, Width, ( )
Frontage, Setback)
5. Other (see comments) ( )
COMMENTS:
'/ I Pl/~ n-1~ ~
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T /7" -.S:L S 'Z t..j TAX LOT
CENS\,. rPj\f.T .
1ST fidei. tv C.a I7le.r 6l//v 1I ( G~3
APPLICANT: hi ..j./ /'
NN1E 1M . O//'fr" CtWlf L-i.JfJ ..
ADDRESS
PHONE
DATE
J-:l y..:.. 7Y
NO YES
DATE
NAME.
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BUILOfNG INSPECTION SECTIDN NOT NO YES NAME DATE
aDD I ".cab I e
6. Plans Submitted ( ) ( ) ( )
7. Soil Stabil ity (footings) ( ) ( ) ( )
8. Flood Plain ( ) ( ) ( )
9. Other (see Comments) ( ) ( ) ( ) C:1I~L /-31 - 7 l./
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COMMENTS: V
NOT NO YES
aPD~i)able(~ (~
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13. . Other (see Comments) ( , () ()
COMMENTS: ~/6 f P74v...."r[.A..b~'-7f-.e.r) w;fk S-l~, ih50ec.:.f..n,~-
Cfr>.e./ rh~ -Wr-fl-. Y")'\,'">+ CtcC-f:r:,Tq..lle.. v nu \, ~ \. '
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SANITATION SECTION
10.
Sewage D i spos a 1
11.
Usable Area
12.
Water Supply
TO APPLICANT:
S2~~~~our
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1-12-7t--(
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DATE
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Building Permit / Site Inspection:
Can be app roved.
Cannot be approved at this tim~ as indicated on item NO. \) above.
Questions and further information on items I through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on items 6
through 13 contact the Lane County Buildinq and Sanitation Division.
Will be held in this office until you can resolve the problems indicated.
Is being returned.
Your building permit appl ication fee is being returned under separate cover.
( )
( )
( )
LANE COUNTY PLANNING DEPARTMENT
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT. 231
C55-28
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT. 411
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. ',' .. . Surname Twp' ./.
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Name
and
Address
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C)lf), ~i ~ -;. ,\",ryx-f: ry r~~ ~~ trt r;,.....;-C", f..
Section;) ,. Tax Lot Code ~
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Census Tract
n,;:~
Range
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Receipt No.
IDate " ,.
_fiPt"iltr;L.":-.";,1 ~>..~ '~()?g~
~:~~(', ~"'~110'" ~"'rfiI"" ~
. Owner
\ Owners Consent
Yes \1 No
:~\ -p .
REQUEST FOR SITE INSPECTION
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE
BUILDING PERMIT. ANY PLANS OR EXPENDITURES MADE IN RELIANCEUP9WTHIS REPORT
ARE AT YOUR OWN RISK:
t1eg\<:i?1vQr to['iJ5\c7'lDC~ hJi1I I!;o.
~ :Ii ~ e; , V)(u)
No. Sites
$
No. Acres
TOTAL $ R~.;f)T::
4o~4 f,4t: P fR1
5r'l7' CAGY p n TI rc;L {fi)ri'!:>llfj~'Mf11
Telephone No.
7b.i7,..,("J~"?TI
Property Size
Applicants Interest in Property
Proposed Use of Property
l!'R;f?I\\':-r.> ",h, Hr'; C;v
1,..7.l K II ~# tflr-q,.", ~ n ~ .Site
Urbanizing "Area
Yes No ~I
of a City?
Yes \1 No
!fIr'llm!')'" ~ ~ 1/1',"1] "..
Legal Access - Road Name Special Permit Area
Yes No ~
Is Property Within One Mile
What City? ~~ri't~~~tmTI~
other
Specify
Existing Structures
I'J~'71n
Proposed Water Supply
Public v District
Sprin~
Well
Property Location: (Directions)
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APPROVED 'nf
(See Below)
NOT APPROVED i~;i~:,i".OTHER>'H."
i': r;, ~"'.""l' . ,'- ..'"0,....<
REASON FOR NON-APPROVAL
STATUTORY AUTHORITY
ORS. 431.130 and 447.020
5i~G m~o~g m~~Nm~ID 5~0~0 ~t~~~Drdg ror Sow@ge
i))i5['@S@U Sv~~em'l.
OAR 41-020 Par. 1
Insufficient lot size
for individual sewage disposal
and water supply.
OAR 41-030 Par. 1
Heavy impervious non-
absorptive soil.
OAR 41-020 Par. 1
Water table above
minimum State Standards.
other
Pl@t ~IGn Dubm~teGd ~~th I!to Ingp8ctlon 15
MnrG~Ui$tic a~d ~heref~rG ~~~CCG~~ob~e.
Engineer~d Site Modification Feasibility:
Possible Not Recommended:
BEFORE CONSTRUCTION IS STARTED bring this form to the Building and Sanitation
/
Division and make application for a building permit. If the property is a portion
only of a tax lot, a metes and bounds description of the parcel must be furnished.
Exact specifications for the sewage disposal system will appear on the building
permit. Two sets of the building plans and plot plan will be required.
LANE COUNTY BUILDING AND SANITATION DIVISION
135 EAST SIXTH AVENUE, EUGENE, OREGON 97401
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Date
C55-32