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Permit Septic Tank 1994-12-4
_T'T '", .. -fRs, TL n 02- I Q Inn SEWAGE DISPOSAL SITE EVALUATION / S.L # 9~ -g 7 /-/~&V Lf"~e:' A. '-e;~ Written Directions (;0 TO 3/),.<:;o ~(Jp"" F3r,cl"r-' ~ c;.(Jttd' s "e:. 'So 1/7, C1rn..... Ln, n"'-Ifl dooc- Tn 'T"he.- ell-:=''- Job Location " Subdivision: 9"1-P0-55~ Lot.:l Block APPLICANT'S NAME AND ADDRESS su'tJhe;v tIoltl h..-":/X'.-:o ~d ~ t:vJ(. ,I OWNER'S NAME AND ADDRESS .":iArM-L:- STRUCTURES NOW ON THE PROPERTY LI-1, , (' ~oz;I/2.e;..5 WATER SUPPLY c. IT'>" 5rnd. f)r ~"\I"7~ Phone 7~ 3; ~'5 Phone ~ PROPOSED USE OF PROPERTY AI~w J.h:>~~ I hereby certify that the above statements are true and accurate. and that I have the following legal interest in the property: ~wner of record; -contract purchaser; "'otential buyer; ----l'ealtor or agent I further certify that (if not the owner) I am authorized to act for the owner of record. and th~d owner is aware and approves of this action. . TEST HOLES READY <A~~ - / "Signature .M/..L&u~ Dato /~'-";<-j1~ , , /",(. . . . . . * . * * * * * * . * * . * * * * * . . * * . . . * * * * OFFICE USE ONt.Y BELO~IS LINE * * * * * * * . . . * * . * * * * * * * * * * * * * . . . The area des~he attached plot plan dated II THIS REPORT IS NOT A PERMIT FOR SEWAGE SYSTEM INSTAllATION /A-ho-J / / ...:fA ~F 4fl<l. '"'i~ is 1;,~ c '1 for a 'lystem, ADDITIONAL COMMENTS: ~n t..M- ~_ , , NOTE: If this report approves use of a sand filter or pressurized distribution will be required with the installation permit application. :s.~ system, detailed construction design plans . ~ * * * * * * * . * * * * * * * * * * * * . * * * * * * * . . * * * * * * * * * * * * 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. * * ' * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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. l/q-'h-;;- OED AUTHORIZED AGENT / rTE LANE COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8TH AVENUE, C55-32 EUGENE, OREGON 97401 (687-4051) .' - -... -.. - -'~ .- - , -, '\ '\. r.:. ""...'....'" , -. ..., \..~,-~~'~"..... ,).'__-' ,L _ \ ,..~+, __I .....'~ '- _\. " - ", ", ) } , '11-', .. , ': ) f v' , '.. . - ,to I. , ~ . " '. .'''(" ,l \ ') " "., .. '. l' , '. \ ' \. \, - J\" '\ 't' . , Lane ii . ".\ MEMO TO: APPLICANT FROM: LANE COUN;r,YENVIRONMENTAL HEALTH SUBJECT: CONDITIONS OF SITE APPROVAL <-' \ '" '. : " . - , \:-" . . 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 describea above will not be further partitioned or subdivided and that conditions on subjeCt or"-adjac~nt properties have not-bean'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 yoid this report. 3. This report is valid until an on-site sewage system "i~ in'st~li~d ~u'fsuant to -ci construction permit obtai~ed 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 subs'urface sewage disposal systems, A certificate of satisfactory completion will not be issued if person other than the above perform the installation. , .' \ " -.:.' - .- .'-. .. ~.- - '" '. r. ~< .' ,{~: \.t.. ~t;'~~~:;' .. r...,.,' ''1"''.: . \ ....;...":'. .+ ~.",,,,.t .,..... . . ,.. .F'...,I..... ,. 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" ~-~, '", .,...,'..... ><ic..,.?'.... ..~..~,"-1",/:~ ;j ,~~.::.}~';..:,~,.:,: .~:.~.~~~~.;~.r: . . , ,,;;,.1 . ".~ .'. r~ . , . " ~~\~."j " . . };' '?j";' \', "~ItJP<il~ ; '" . . .., < I '. ~f~l"j 1H.I1' 1F'D"<oA ., '" ,', (PAV~P APIt(;)N' , ,,5P -- ...,- - '~ --~ .... -t\ IRe.P/IIC€ .4WIlT ~p~* / -.!!!' )-(~\; ~ i j. I ~ ...._11-. '--.1:',' --- I.. . "". -~; -- ....r- -~ ~ .~ .~. _;_ 'l -- "'1 I~. ~. I ,,' : . .' ~I . . ~ ,j ~ ~ . ~,\ . .1 ill . tl ... ~ e<1) !h .i 9 :II lB .!l! ~ ~ ., eI ~ , t .f ----~ . ,~ \: .. F" . ~ . e e e ~ V !11\ , . . e . m~ e . W: ~ LANE COUNTY DEPT ENV MGT RECEIPT I 940517 DATE 120894 APPLICANT MILLER, STEPHEN ADDR 3850 HAYDEN BRIDGE RD., SPRINGFIELD . TU' 1702190000100 SUBD I V ' I..,ClT BLK e NEW BLDG TYPE USE X BDRMS 0 UNITS 001 STORIES, IBLDGS001 PHbNE 746 3185 OWNER NME MILLER. STEPHEN ADDR 3850 HAYDEN BRIDGE RD., SPRINGFIELD . CODE APPI... NO ACTION' DESCRIPTION S(~ FT UNIT COST VALUATION FEE DAY. Bp "I, , _"D, !6n~p c ,1~ .BP, e~ t(p . BP B .PL IFIX/F.<ATH: Sl,.Jr\: FT. WTf~: FT. RAIN: FT .~ MECH MECHANICAL FEE .SUR STATE SURCHARGE ~>I.' .~ PCK PLAN CHECK FEE ~ SI LC 940517 SI I 270.00 270.00 ~ . SDEQ FEE SI :5~). 00 e ~ , ~ I ' ,., ",J,' ! 0.; I r, :~ . .~ CATG: pLN F\f~ SDS n,E PCK ISS / SI OTf~ ' J SEQU: I 15 ~ eTAI<EN BYRLH [ST. COMPLETION DATE DEPOSIT H :5()~).00 CK el ; i ! e, .' e 'it . . .