HomeMy WebLinkAboutPermit Plumbing 1991-7-22
SEWAGE D'ISPOSAL SITE EVALUATION 06tJ-.::V~:~"#-c7/';/9
f~-(JJ-f):)"-t2 9000 Job Locallon NORill wEst CORNER <!iF ./,1.S?ER /(1) ,4.HD
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SubdiVISion
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Lot Bloc~
WATER SUPPLY
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APPLICANT'S NAME AND ADDRESS I(PI/! N
OWNER'S NAME AND ADDRESS 5A-/<1 r;..
STRUCTURES NOW ON THE PROPERTY
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PROPOSED USE OF PROPERTY
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Phone '7 '/ b <{IS- 'i
Phone S'rt me:
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I hereby certify that the above statements are true and accurate, and that I have the following legal Interest In the property -K-owner of record, _contract purChaser', _potential 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 z~s~ware Jgd J61lroves of this action .
'r'TF=STHOLESREADY."?/~ (:~) Signature p ~'~__./.b~ Date ?-/S- ? I
~. '" * * * * * '" '" '" '" * '" '" '" '" '" '" '" '" '" '" '" ~ '" '" '" '" '" '" * '" '" '" '" '" '" * '" '" '" '" '" '" '" '" '" OFFICE USE ONLY BELOW THIS LINE * '" '" "'!. '" '"
'" "'... '" ~ '" "'... '" '" '" * '" * '" '" '" '" * '" * '" '" '" '" '" "'.. '" "'. "'.. '" '" '" '" "'. '" '" '"
SITE MEETS STATE STANDARDS YES NO YES NO
Standard System ;.t 0 Low Pressure Distribution 0, 0
Sand Filter 0 0 Holding Tank 0 .0
1 Foot Capping Fill 0 0 Other 0 q
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2omn,:,
Partitioning #
LAND USE COMPLIANCE
4.creage ~or Lot SI70
Parcel #
'TOTAL)
) Completed
) Pending
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COMMENTS
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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
s;x:;f' ~ a ~ -
.. AUTHORIZED SIGN~E
LANE COUNTY ENVIRONMENfAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (6b7-4051)
C55-32
o Floodway
7-LL ~7 r
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 floodmg
Allor 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 10 a ffood hazard
area In which a floodway has been deSignated
BUlldmg may be prohibited subject to
demonstration that the cumulatIve effect of
proposed development Will not Increase the
100 year floo~d level at any pomt
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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 proh.bltlssuance of a permit In accordance wIth
o R S 454605 through 454755 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
automallcally benefit subsequent owners
Only persons haVing a valid license Issued by the Department of EnVIronmental Quality under ORS 454695 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 complellon Will not be Issued If persons other than the above perform the InstallatiOn
Tax Re["erence
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Date
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SUM1V /
Part
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Parcel( / Blk,
SITE EVALUATIO J C'U1.D WORKSPEET ~ #
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ZonIng ________~St
Parce I SHe
Water Supply Well Conrnunlty PublIc
Depch
Texture
So~l Matr~X Color and ~ottl~ng (Notat~on) 'Coarse Fragmencs p~ts,
5truc~-re, Layer L~~t~ng Effece~ve 5011 Depeh etc
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=m< SPECIFICATIONS
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PLOT PLP,~J AP?ROliED
A permit IS reqUired
pnor to starting construction
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EnvlI'on:ntntal Health SeNices
125 East 8th AvenuV'
Eugene, Oregon 97401
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LOCATION
NAME
ADDRESS
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The Lane County BUilding and Sanitation DIVISiOn cannot proceed with processing your application because
1 0 Incomplete application (Items deficient)
o Address and/or directions to application site
o Proposed number of bedrooms In dwelling
[f;] 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 dralnflelds
4 0 Other ,,,,""U"'Pu' ~'" _ "J_~ "'-fo~- ~~4 Pn.
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PHONE
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If no response has been received In regards to thiS matter by
the appllcallon will be denied
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LANE COUNTY ENVIRONMENTAL HEALTH SE~~ES
Courthouse-publlc~Vlce Bldg /125 E 8th Ave / Eugene, .7401 / 687-4501