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HomeMy WebLinkAboutPermit Plumbing 1989-12-27 . SE~lGE DISPOSAL SITE EVALUATION S,I.11 fr-o~7 TRS,TI/7-tJZ-/9Y(/ ;7??o Job Location r~;hY..?'E/V',.ff~.-.:{&:..dL7.. _(/~~r~ Written Directions ~.H"'/"4"'-#~ /.-'Crr-'/'O .d,y'.d~A/ .;:?~..cP- Arr-B'/U.r~;;/ .&z-.#'-::~L2:'~~ ~~ Lot ,Bloc~. /? .,TER ~PPLY . /rr?,:f-"Y?~C?7~ /b-7 ./ - APPLICANT'S NAME AND ADDRESS k~K / / ~ot":" ~ .,;;?iYs-.f/ d / 7- _ r;;; (')t?.r;;-~ 4f}? 7 po' ~/ Phone~~ ?"...?~ OWNER'S NAME AND ADDRESS:. pA/ ~/:'r?'A('f //'.5'4 A??~ Vj. r ~L.h??~ /7..P~_~p ;?~~7&{ Lf eSTRUCTURESNOWONTHEPROPERn rF~ ~~~ PROPOSEDUSEOFPROPERTY......r-&r.zz:;>~I""~ , I hereby certify that the above statements are true and accurate. and that I have the following legal interest in the property: _ow r of record; _~ont, act purchaser; _potential buyer; _realtorOragent.lturtherce;i):h.~#o~OWner)l~authoriZ~t actfortheownerofrecord,andthatsaidowneris w and appro fthis no))? - . J / TEST HOLES READY .L !... _ ~g. Signature X ~Dato.k' / L /5/.;9, Subdivision: ..**************.*.***************************** * * OFFICE USE ONLY BELOW THIS LINE .*.*.....*......... ........ ......... ............. ......... SITE MEETS STATE STANDARDS YES NO YES NO Standard System 0 0 Low Pressure Distribution 0 0 Sand Filter ~ 0 Holding Tank 0 0 1 Foot Capping Fill 0 0 Other 0 0 LAND USE COMPLIANCE zoninQ-E.,. yo Acreage or Lot Si7A -l ) Completed ) Pending COMMENTS' A,..~I.:o......, "*~ ~",,-'.-LA ~J.' LYJ' I{. 't2"'~ ttfJ. . UJI d ~. , " - Partitioning # - ~~~~.~7~ ,r;~L.J. ~.-.d aM- LJ~ ~ _ ~2 --:) ?dl ~.h..e..- .:..a,q,. ~./I7L a... ~ .. /:~ ~.;; ~L,-,-..L."/ .~;f- p~, ~ ~ c[:J/ti;-v- 1~"I1 ~dv ~4.t../~a:..d~ > ll2n....u~ ~/ ' (1OTAL) Parcel # )..../< I~ -ls-rJ? , 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 SITE IS APPROVED, SEE REVERSE SIDE. ~~E- - -'\......- -'AUTHORlZED SI URE LANE COUNTY ENVIRONM TAL HEALTH, 125 EAST 8TH AVENUE. EUGENE. OREGON 97401 (687-4051) C55-32 D.eloodway /,;}. -.2 7-Y'1 DATE 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 floodway 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, part,itioning 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'<:>quivalent. 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. . . . ~~ < . . --- (3 f{ i J <L 'R1-- \ 00 , \'l ~ ~~~ ~ # MJ e rJ ~ 'V> ~ _ ~ t1-- ~ ~~ "" ~ rt ~~V ot./..~f~ r,ft {'V-'{ D - ~EVALUAnCll FIELD WORKSHEET .-n Evaluator: ~A/ tJ r1-zif Tu RGtCMlDC'8 /7 -0)..: -/1, t/ / (!~ /2-'- Z!..-ff I L=bcape Hot.. oaHLJ' ~~ Slope / 0 ~ {.poct - . J Crouodw.ter O\.l1er S1to Hote. kd./_ ~ ..:J.cl k......- ~~~. M 4.P-' .~4Je.]j ~~_~~ ~~.~('> ,II' . ~-1;;!iB1J?!:1~~d:Jr~~' . . . ~ Sy.t=~ 0. ~ Dc31gn n", tE?J ~ Wtbl ----Sy3tcm SUing SO.k:. 11~ g. !i4x~ Depth Absorption Facility (in) Heplac=ect ~ ~.ot'" 5'-'-" . (?)~ "50 g. u_ h "'1 ......~ .__x. [)cpt Ab~orption Facility (in)' Appllcant Oepth 1t t .f)-Oll /3,AJ 1t 2 ,0-15" IS: 2..2-' z.l- (') ~ ,.To 1t . .../0 -..:J,J 33# ?At A Spoo1al Cond1t1CC3 Texture 5;"' C L. ~~ t1 S,'C ~ ~.C- ~../ ~ Date: Soil Matrix Color and Mottling (Notation). \Coarse Fraqmeaes. Roots, Structuro. Layer Limiting Effectivo Soil Depeh. etc. . ~~. ~., LL~ . , I , - ~it ~,...R~ /.....) /)~ / / / / '- ~ ~ _ /Ir~ ~A"'L / fe,iJ (; rJ ' V M /11-kVX.. A~, ~. --6 ~ 1t1;/IL rtll. f/' -C' ~ A~f)1. r(j-- ~ d /tf'11 /0 y,e 'IL- I .J :u,' L-... -Id ~- ISO' 2-1 t J-'/'" :.......:.,.., ".","'.' ., '.' ... .,. ". ....:.~ ., ",(.,',,: .'. . Please complete all lines inside white boxes, if possible. I ~./II )f11 ~y~~!? ZIP . '24/,.7(. /3 .$,a/IJ~ 9?V'?7 l,.;UNIHAI,,;IUH ucen.. . Existing Buildings or . Imp'rovemenl,S on P{9I'erty IZtJ House ~ ~:~ge- ~ Mobile. Home CJ Shed SEPTIC INSTALLED CJYes . CJNo ,P rid."J':~""d Ill!J I; " rl!AILlK il. C-~ S-S YOUR N ~ e:; 'Lb'1 {/) _ / '2 ~ .s/ ,u"n~""~ld ~~ r: CITY , OWNER O~R~R~' _t u) t!..i S C l>€. IkAtf..>I::'Q +- ,,~ Jjf1D OWNERS ADDRESS (t1 not Mm. as .bov.) , ZIP )> , '." , SITE ADDRES~ clel'..l ~l:t,! rL1e. ~cL ZIP , ~> . MAIL PE~.eA A.J J( L. "AMI;; .uuwe>> ~~o/tf --" I,,;IIT C~ ..s s J r1 (:;A .s~~ ,0 I't ~/}1..111 , ZIP For Mobile Home Placement Only Brand Year Size No. of Tip-outs No. of Bedrm" License # , ......,......: ,. ..,. ,....:.~.:.:~.:: Land Management Div. staff can not be held responsible for evaluations or recommendations based on false, Inaccurate or Incomplete Information "': .::f,..r:'/,~:.~:l:~:>;..,..<) . . . e e ; ~ ef I. '.'. LANE COUNTY DEPT ENV MGT F(ECEIPT ~ 890228 DATE 12158~' ~ APPLICANT BRISCOE, JON ' ADDR 1830 MARKET ST., SPRINGFIELD, OREGON~ TU' 1702194100900 SUBD I V . LOT BLK f. ,'1 NEW BLDG TYPE USE X BDRMS 0 UNITS 001 STORIES ~BLDGS 001 PHONE .746 4383 ' ~ OWNEF( NME ElR I SCOE, JON 'ADDF( 1 830 MAI~K ET ST.. SPF( I NGF I ELD. OI~EGON~ CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DAyS BP ~BP ^~ 't ~P '. BP ~BP ~ PL ~FIX/BATH: ~MECH !SUF( PCK ~SI L.C 890228 SI SDEQ PASO FEE ~ SWR: FT. WTR: MECHANICAL FEE STATE SURCHARGE PLAN CHECK FEE . 1 r ~ 1 CArG.: ~SEQU: , TAKEN BY APP 1 RLH RA FP . SDS SI PCK ., .. EST. COMPL.ETION DATE ~ e . ) . ~ FT. RAIN: FT 5% ~ ;11 e 160.00 160.00 15.00 25.00 ~ OTI-I ISS 3 DEPOSIT ** 200.00 1~ CK f , er I l' ~.: , ~~ . .