HomeMy WebLinkAboutPermit Septic Tank 1995-2-27
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____:n~~-_-__--- - SEWAGE DISPOSAL SITE EVALUATION
TRS:TL t <a ":'{f3 -0"2-. :;"/i qogb Location Se.e LAJ~' Qh "SrI?€, p~
_ I Written Directions L6ftAffi.1L a.fJ Dna('.:> 4 PtA.;,t;
Subdivision: ~~ I-J-.g '51&1;;; . \ AU=tL L:br
Lot I c; Block .1 '"Z- WATER SUPPLY ---J,JwIC
APPLICANT'S NAME AND ADDRESS JOJ-,A..J l3r ~ ':> 1'+7 F ~
CSkh1.f2.
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OWNER'S NAME AND ADDRFC:C:
STRUCTURES NOW ON THE PROPERTY
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9i1-0/83
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PROPOSED USE OF PROPERTY
Phone Y' f t;: ~~
'7 "f:F- - yq.5~
Phone .
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1 hereby certify that the above statements are true and accurate. and that I have the following legal interest in the property: ~wner of record; "'ontract purchaser; "otential buyer;
~ealtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of record, and that sa~r i~are a~pproves of this action. , L
.ST HOLES READY t-j e.::;. Signature ~ tJ:::/~.A"f DP'"~S;C -.&f T.
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. * '* * * * * * * * * '* * * * * * * * * * * * * * * * * * * * * * OFFICE USE ONLY BELOvf1"'HIS LINE * * '* * * * * * * * * * * * . * * * * * * * . * * * * * ..
THIS REPORT IS NOT A PERMIT FOR SEWAGE SYSTEM INSTALLATION
Z/Z7 Nc:-
The area described on the ~Ched;::lot n dated
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ADDITIONAL COMMENTS: (V /?;Z/ rF 'T.7/Z4tfU R cZ...p
.
is
APPllout]?
for a
, .
system.
.;tOTE:
. this report approves use of a sand filter or pressurized distribution system, detailed construction design plans
will be required with the installation permit application,
)
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
R'SK. ~PROV'D. m RMRS' S:~As-
t:/" WEQ At9THORIZED AGENT . ~AlE
,
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
. .
. WARNING: .
. .
. This Site Evaluation is a technical report to determine if a on-site .
. system will function properly. It does not approve the proposed use of .
. the parcel, This Site Evaluation may be converted to a construction .
: permit only if the parcel and use meet land use regulations in effect at :
. the time of application. YOU ARE URGED TO CONTACT YOUR LOCAL .
. PLANNING OFFICE FOR LAND USE REVIEW. .
. .
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
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LANE COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051)
C55-32
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,
MEMO
TO: APPLICANT
FROM: LANE COUNTY ENVIRONMENTAL HEALTH
SUBJECT: CONDITIONS OF SITE APPROVAL
Lane
ii
.
1. Any alteration of the natural conditions in the area approved for the on-site system or the placement of a well within
100 feet of the approved area may void this approval.
2. This approval is given on the basis that the lot or parcel described above will not be further partitioned or subdivided
and that conditions on subject or adjacent properties have not been altered in any manner which would prohibit
issuance of a permit in accordance with O,R.S. 454.605 through 454,755 and Administrative Rules of the Environmental
Quality Commission. Any such subdivision, partitioning or alteration may void this report.
3. This report is valid until an on-site sewage system is installed pursuant to a construction permit obtained from Lane
County, or until earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department of
Enviromental Quality to the owners according to Department records or the County tax records. Subject to the
foregoing, this report runs with the land and will automatically benefit subsequent owners.
4. Only persons having a valid license issued by the Department of Environmental Quality under ORS 454.695 to install
subsurface sewage disposal systems or an owner or contract purchaser or his regular employees may install subsurface
sewage disposal systems. A certificate of satisfactory completion will not be issued if person other than the above
perform the installation.
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The Lane County Building and Sanitation Division cannot proceed with processing your application because: I
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HOLD SLIP
APPLICATION #
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NAME
ADDRESS
ZIP CODE
1. 0 Incomplete application (items deficient).
o Address and/or directions to application site.
o Proposed number of bedrooms in dwelling.
o Approvable plot plan (see attachment).
o Notification of date test holes will be ready.
2. 0 Verification of existing system required (see attachment).
3. 0 Two test holes (2'x4'x5' deep) required for expansion or repair of existing sewage disposal
system in the area of the proposed drainfields.
~
4, ITJ. Other' . .. .__.__
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If no response has been received in regards to this matter by
the application will be denied.
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
Courthouse-Public Service Bldg. 1125 E. 8th Ave. 1 Eugene. OR 97401 1 687-4051
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. W: 3 LANE COUNTY DEPT ENV MGT RECEIPT ~ 940183 DATE 060994
APPLICANT BRIGGS, JOHN ADDR 747 F ST., SPRINGFIELD .
1:; : TL~ 1803022001900 SUBDIV LOT BLI(.,
NE'W BLDG TYPE USE R BDRMS 0 UNITS 001 STORIES ~BLDGS 001 PHONE 726 0137';
. OWNER NME BRIGGS, JOHN AD DR 747 F ST., SPF(INGFIELD .
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAYS
BP ,\
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BP ,
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~FIX/BATH:
SWR:
FT. WTF( :
MECHANICAL FEE
STATE SURCHARGE
PLAN CHECK FEE
1
FT.
RAIN:
FT
5%
25%
LC 940183 SI
FEE
SI
200.00
20.00
.
. CATG:
SEQU:
TAKEN
PLN
F(A
SDS
ELE
PCK
ISS
/
SI
1
CITR
BY MLC
EST. COMPLETION DATE
DEPOS IT H
.
,l.,,'
.
SEWAGE DISPOSAL SITE EVALUATION , J'7?-ar
,,eJ JF vi3' /(I~ ./ - S,I.#_
TRS.TI /0 -c:J.5-t/-2.2 /.9dV' Job Location -. . . /.4Y./_~J:' ~4:.q a/. ~ .
WrillenDirections p~/~I- 0~~ -d- ~~~ ~AW~..../
_z:-- ~d'P'.4) ~~~~...e---?........ /::1& ~~..R'.../) "'~}
Lot Blocy _ -. _ wA4ERS~PPLY ~~~~........./~~
APPLlCANT'SNAMEANDADDRES~~~~./ ~f",..<'P.k-4g~;....~ ~~.:" ~7~/Phon~ -U~ff"..F/....r
OWNER'SNAMEANDADDRES~M'~~~2..:-'~ ~~Ab'~;4?;.~ .,c.,e,4.~. P n.. ,.:{.~-..JJr/
STRUCTURES NOW ON THE PROPERTY ~ 4A~ ~ ~.-J PROPOSED USE OF PROPERTY ~~__..R'
_ / J-
I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: _owner of record; _contract purchaser; _potential buyer:
---X-realtor or egent. I further certify that {If not~authorlzed to act for the owner of record, and that said owner is aw~re end app,""fs ~f this action.
eTESTHOLESREADY $~ Signatur"----rvt.w'.d[...J..(Q~~ Datp 7-2(..-fi'1
'3/' ..
, .
Subdivision:
... * * * * *.... **.... * *",o,"" *.. ** * *.......... ** *** * *.. *.. *.. * ****'* ** OFFICE USE ONLY BELOW THIS LINE ***...... ...... **...* ... ................ ....... *. ...
Partitioning # Parcel # ( ) Completed
COMMENTS' Vb/!?- ~~27
/' //
SITE MEETS STATE STANDARDS YES NO YES NO
Standard System 0 i( Low Pressure Distribution 0 fl{
Sand Filter 0 I1'J Holding Tank 0 !5i
1 Foot Capping Fill 0 r;( Other 0 ~
Zonin,:,
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.
LAND USE COMPLIANCE
} .creage or Lot Size
rroTAL)
FLOODPLAIN INFORMATION
o Approximate
Study Area
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 SIT S APPROVED, SEE REVERSE SIDE,
,......,A . ~-r~-P'1
--~R1ZED SIG!IIATURE DATE .
LANE COUNTY ENVIRONMENTAL 125 EAST BTH AVENUE, EUGENE, OREGON 97401 (687-4051)
o Floodway
CS5-32
All or part of this site may be in a flood hazard
area for which 100 year flood levels have not
been established. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part of this site may be in a flood hazard
area for which 100 year flood levels have been
established. A building 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 a f100dway has been designated.
Building may be prohibited subject to
demonstration that the cumulative effect of
proposed development will not increase the
100 year flood level at any point.
.... ......
MEMO
TO: APPLICANT
FROM: LANE COUNTY ENVIRONMENTAL HEALTH
SUBJECT: CONDITIONS OF SITE APPROVAL
lane county
-
.
Any alteration of the natural conditions in the area approved for the on-site system or replacement area may void this approval.
This approval is given on the basis that the lot or parcel described above will not be further partitioned or subdivided and that conditions
on subject or adjacent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with
O.R.S. 454.605 through 454,755 and Administrative Rules of the Environmental Quality Commission. Any such subdivision,
partitioning or alteration may void this report.
WARNING: This document is a technical report for on-site sewage disposal only. It may be converted to a permit only if, at the time of
application, the parcel has been found to be compatible with applicable LCDC-acknowledged local comprehensive land
use plans and implementing measures or the Statewide Planning Goals. The Statement of Compatibility may be made on
the attached form or its equivalent. Authorized Agent approval is required before a construction permit can be issued,
This report is valid until an on-site sewage system is installed pursuant to a construction permit obtained from Lane County, or until
earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department of Environmental Quality to the
owners according to Department records or the County tax records. Subject to the foregoing, this report runs with the land and will
automatically benefit subsequent owners,
Only persons having a valid license issued by the Department of Environmental Quality under ORS 454.695 to install subsurface
sewage disposal systems or an owner or contract purchaser or his regular employees may install subsurface sewage disposal systems,
A certificate of satisfactory completion will not be issued if persons other than the above perform the installation.
.
2...7
SITE EVALUATIOll ftn.D WORKSHEET
19~ . Ev>.lua",.:
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7
Soil Matrix Color 4nd HOttlinq (NOtation). 'Coarse Fragments, Roots.
Structura, Layer Limitinq Effectivo 5011 Depth, etc. .
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Please co'!'plete a./1 i!~es inside white boxes,
---rn"" I /} d f W .JJu/l~
if possible.
0-? -f1
'tUUtt ....AMt:.
DArt:
mrrrt~~.a W,~Od 1f7
6, -;f^,Jl. I'f<
CITY -'-"~
~,,{fJA,/ fl'1<'[1o;vpJ,
OWNER OF PROPERTY (il not ..m. .. .bon)
~3oo 5,,,), Pd...~V~.\ D",A- ~ Ibf1...
OWNERS ADDRESS (II not ..me .. abov.)
B j) b "S+o VV' S
l;.UN I HAc'; (l.ltt
'-1'64-1'610-
"HON!;
q7LfDI
ZIP
. 1"'i54~,,..!.il..-
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" ....'10, dZ. q7D 1r
ZIP
Llcen.. .
,
.
MAP, PARCEL NUMBER
l't.. o. ..:~~ I. thoAi....2nt~ 'OOOOot q;'~
~ anae uft:uon ll4 ~C:I,on lall Loi
Townahlp n::;;;- Section 114 Secllon hx LOI
lownanlp ~ tiKIlon 1/4 Seellon IU LOI
,
.
SITE ADDRESS P _
All.) (Dv...vv}j-f 0,..,,,,,'( 't 1M
~orftd ,
.
..,
.
-....
MAIL PERMIT TO: - '\ ~
YrG, (.0~ C-YA i~
1\ L\;,), L.~I HA"J' lbf:O Q d tL 'I
E'~UH'N!. 1)((. 9 ,W" I
J
I'U'Mt:.
IUIUHl:.ljljl
l.OlIY
ZIP
,
.. .
.....'..,..................;.....
S!AfFEVALUATION .i
.'..ij,formaUo~~eq~~.t. Only
{~g~Ng~r~~j
'.'
....::;.;~......::.,.....: ", :..:':"
.Tl'l5Verlfled ....
>Allowed User
,..C:JYes. . NoC:J,"
'c:JYesNo c:J <;
.
..
land Management Dlv. staff can
not be held responsible for
evaluations or recommendations
based on false, Inaccurato or
Incomplete Information
...
.
.
........:..,.
.......,.,
Existing Buildings or
Improvements on
Property
C:J House
C:J Barn
C:J Garage
c::J Mobile. Home
c::J Shed
SEPTIC INSTAllED
c::J Yes
.G:J No
v Water District
..
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"
Directions to site
from Courthouse
R.:.ve...- PtW....... S.5k~
(~Th. 2.'\1 S/\ tb
O~~,,'~ ~H-a.-...[1r~~
ib CO~~ Jr o,vri,'I"
P. ,/ ---....--
I Ae.( ^' <-0 (,.,e,,;ff!..
'-.... --- ~
...
criL/li
ZIP
.
~..:
For Mobile Home
Placement Only
Brand
Year
Size
No. of Tip-outs
No. of Bedrm-
Ucense ,'"
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.
.
. LANE COUNTY DEPT ENV MGT f~ECEIPT ~ 890129 DATE 07268"i.
.' APPLICANT MCDONALD, EDWARD ADDR 1142 WILLAGILLSPIE RD., EUGENE. ORE~
TLI 1803022001900 SUBDIV LOT BLK
.NEW BLDG TYPE USE X BDRMS 0 UNITS 001 STORIES ~BLDGS 001 PHONE 484 981~?.
OWNER NME MCDONALD, EDWARD ADDR 1142 WILLAGILLSPIE RD., EUGENE, ORE~
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAYS,
. BP ~
ElP .
BP
.BF'
BP
"1 "
.F'L
MECH
SUR
.PCK
SI
SDEQ
.
CATG:
. SEQU :
': '-AI<EN
.'
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.'
IFIX/BATH:
LC 890129 SI
APP
1
BY RLH
RA
SWF~ : FT. WTR: FT. RAIN:
MECHANICAL FEE
STATE SURCHARGE 5%
PLAN CHECK FEE
1 160.00
\
FP SDS SI PCK OTH ISS
2 ;3
EST. COMPLETION DATE DEPOSIT ,)t.*
.
.
.
FT
.
160.00
.15.00
.
i !' ~
.
1.
175.00 CI(
.
.