HomeMy WebLinkAboutPermit Septic Tank 1988-12-27
SEWAGE DISPOSAL SITE EVALUATION cPcf-/76'
10 ...... S.1. #
17-02-19.4.1 TL 'AJ.Qe' Job Location :~'15'-\ HAYDEN BRIDGE ROAD, SPRINGFIELD, OREGON
Written Directions LEFT ON HAYDEN BRIDGE ROAD AT HAYDEN BRIDGE, ON THE RIGHT SIDE OF
ROAD AT BOTTOM OF EWEB FIlTRAT~ON PLANT ~TI I
WATER SUPPLY I1I%X PROPOSED WELL
3820 HAYDEN BRIDGE ROAD, SPRINGFIELD, OREGON 97477- Phone 747-4324
1~Phone~
PROPOSED USE OF PROPERTY RESrn.Nr.
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Subdivision:
Lot
Block
APPLICANT'S NAME AND ADDRF"" TERRY C. HENDERSON,
OWNER'S NAME AND ADDRESS SAME AS THE ABOVE
STRUCTURES NOW ON THE PROPERTY NO EXISTING STRUCTURES
I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: . -.XXX.owner of record; _contract purchaser; ~tential
buyer;
_realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of record, and that said owner is aware and approves of this action.
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.... ........................ * * *.......... * *.. *............ *.......... "'............ OFFICE USE ONLY BELOW THIS LINE ..............*....... ..... *.*.................. ..***........
..... ***
SITE MEETS STATE STANDARDS YES NO YES NO
Standard System \li( 0 Low Pressure Distribution 0 0
Sand Filter 0 0 Holding Tank 0 0
1 Foot Capping Fill 0 0 Other 0 0
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Zonin,:,
Partitioning #
COMMENT""
LAND USE COMPLIANCE
Acreage or Lot Size
(TOTAL)
Parcel #
Z-
) Completed
) Pending
FLOOOPLAIN 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, .
~ ~ /.2..-h.7-4
- '--" AUTHORIZED'SlGNA~ -r . DATE
LANE COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051)
C55-32
o Floodway
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 floocIlevel 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.
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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.
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. LANE COUNTY DEPT ENV MGTRECEIF'T ,:; 880175 DATE 110188
APPLICANT HENDEF,SON, TERRY AD DR 3B20 HAYDEN BRIDGE RD., SPRINGFIELD, .
TL':; 1702194100100 SUBDIV LOT BLK ,",
~EW ~l~DG ~YP~ '," l:JSE ~ ,I:DRMS 0 UNITS 0~1,S~ORr.ES. ':;~~DGS:O?1 PH~~~ ,743 .4324
OWNEr, NME HENDEr,SON, TERF,Y (.~DDF, -5B...0 IIAYDEN l,lIdD(,f:. Id)., SFFd,Nr,F]'EI...D,.
CODE APPL NO ACTION DEscrnpTION SQ FT UNIT COST VALUATION FEE DA'fS
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EST. COMPLETION DATE
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Please complete all lines inside white
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'fUUH NAMt./
3?20 ~v)fL... e. Il.)
l:;':~'i"'e /d
OWNER OF PROPERTY (il not ..me .. .bon)
OWNERS ADDRESS (II not sam. u above)
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MAP, PARCEL NUMBER
(Found on tIll map. In the A.....rn.nl . Tlullon Oepl)
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Town.hlp ~ Sec:tlon 1/4 Section Tax Lot
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SITE ADDRESS
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MAIL PERMIT Tq: d
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boxes, if possible.
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ExIsting BuildIngs or
ImprovemenN;s
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SEPTIC INSTALLED
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Water District , h \ ,
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For Mobile Home
Placement Onty
Brand
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Size
No. of Tip-outs
No. of Bedrmo
License ~(
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Land Management Dlv. steff can
not be held responsible for
evaluations or recommendations
based on falso, Inaccurate or
Incomplete Information
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Tu Reference
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A building permit is required
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DATE_I-.;z -.2. 7 r
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Buiiding & Sanitation Oi .' n
125 E. 8tI1 AveJPub. 5oN, g,
Eugene. Oregc:: !),t~Cl
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PROPOSED PARTITION
for
TERRY HENDERSON
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SE 1/4 SEe. 19, TITS, R2W; W.M
SPRINGFIELO, LANE COUNTY, OREGON
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CONSULTING ENGINEElS & SUIVEYOIS DATE: OCT. 3. 1988 ~ 1
207 Q STRE;E;T DIAWN: LARRY OLSON ~ ~
SPRINGflE;LD. ORE;GON 97477 4l0B NO: 100911
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