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......, "*~
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ttfJ. . UJI d ~.
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Partitioning #
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(1OTAL)
Parcel #
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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.
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- -'\......- -'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
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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.
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~EVALUAnCll FIELD WORKSHEET
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Heplac=ect ~ ~.ot'" 5'-'-" . (?)~ "50 g. u_ h
"'1 ......~ .__x. [)cpt Ab~orption Facility (in)'
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Soil Matrix Color and Mottling (Notation). \Coarse Fraqmeaes. Roots,
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Existing Buildings or
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P{9I'erty
IZtJ House
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CJ Shed
SEPTIC INSTALLED
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For Mobile Home
Placement Only
Brand
Year
Size
No. of Tip-outs
No. of Bedrm"
License #
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Land Management Div. staff can
not be held responsible for
evaluations or recommendations
based on false, Inaccurate or
Incomplete Information
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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 ^~
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'. BP
~BP ~
PL ~FIX/BATH:
~MECH
!SUF(
PCK
~SI L.C 890228 SI
SDEQ
PASO FEE
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SWR: FT. WTR:
MECHANICAL FEE
STATE SURCHARGE
PLAN CHECK FEE
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CArG.:
~SEQU: ,
TAKEN BY
APP
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RLH
RA
FP .
SDS
SI
PCK
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EST. COMPL.ETION DATE
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FT. RAIN:
FT
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160.00
160.00
15.00
25.00
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ISS
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DEPOSIT **
200.00
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