HomeMy WebLinkAboutPermit Septic Tank 1975-7-30
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~UEST FOR SITE FEASIBILITY STUDY
()(q-o I AA/x?./
Code C.T. Number 5'Ded,;l1 Permit Area
,.)
THIS IS A PRELIMINARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A
PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR
Fu Offic~,y
Use On I y A ./
ceived by
Yes ~
UrbanizinQ Area
PLEASE PRINT
FUTURE BUILDING PERMIT.
OWN RISK. ....1
If Subdivision - Name:
Lot #
Block #
/7
Townsh ip
~
Range
.:J .L
5ect"ion
</00 J..f ~;;; PJ'6/Vk
Tax Lot NO. Owner of Property
Yes .:x
Owner's
No
Consent
"
(;t" ut'?hl &'",<:1 tl. No. of Sites /
'Name ~ J
& ..,-";/f)o, '/? ,.<::1. No. of Acres
Mail in}g Ad2.r~s,;;'/
'1fr,,'tr'RY ',r),..~ . 9'71/77-.,. Total
?~f- 'j-"/J3 ~<VU c;/J ~--J'1?-1S"~
Telephone # Si~ature ~~I icant Date
$ 7.;-. crt)
$
$
V>
-1 ~cr2)
....
r-
'It
Owner Seller
Proposed Use , I
of Property: ,,(jB4)
~/
Appl ieant's Interest Buyer " ,~altor _
in Property: Other (SpecifY):_~_1~~
..
'Is Property Within on~Mile of itY?/7 I
Yes y What City? "///
~ ,. I
"'7"",- S'
Legal Access - Road Name Exi'st ing Structures on Proper,ty
/
Proposed Water Supp I y//
Publ ic X District:
Spring - Well/Other (Specify):
- / ,
Property Location (Directpio s): cf'LJ ~ "d" C)./~t/~'):.f-, ~/J ~~w"--d!d~
I ,./1/7 /M, '(] II . --M _'I?
,,,," . '~~ f "ff-C/ ~'V'/' .,~ .:2,.,..,/ ~ ~:iJ.,J.f..
oJ:'. ,e::+. ~
When Will 'Test Holes Be Ready? I sY /<//7-:>--- ,
MARK TEST HOLES WITH OUR FLAGS I / '(Date) /
Location of Test Holes on Property: /II.~.- / re~ "'"
Draw diagram of property showin~ location ~ a~,Y.) landmarks
these landmarks: / /1'
/
..
.;2 9" "..Y /:)7>
'Property Size
ip~Of~r
and relationship of
test holes to
,
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xu
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MAKE CHECK PAYABLE TO: ENVIRONMENTAL MANAGEMENT
MAIL TO: LANE COUNTY DEPARTMENT OF ENVIRONMENTAL
CS5-55
Phcn e: 68(-4065
MANAGEMENT, 135 E. 6th Ave., Eugene. Ore,
.
APPROVED
..../.
-....:
,
-
. "
'.
/..'"
"
NOT APPROVED
( N~
C'I Auth~ri d _Sjlnature
V x-; ~/70
Oate
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.-- ~. ". _"' "'IIo.~...,
'i' ""0,,, . Site'"I," 'l,ct{on #.
7s--7/1
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EVALUATION"-" ,
. >X9~"DETEl@N.IN,G SIT,.t .s.lJgA,BI~~Ii' . "
,F9R D~~ELO?ME;NT UTILIZING . .
SUBS~Rf.AC~, SEWAG~:DISPOSAL METHODS
LOCATION:
TWP.
/7
RANGE
/J
.. 6.:..)
SEC.
2 Lf
TAX LOT i:'
L/D6
it <.
Are public sewers available or 'nearby? (Distance)
Are there zoning or environmental considerations?
Y1.
......."
Size of property: {)qCY'(./")0
Amount useable are~
Are other systems in area known: to be malfunctioning?
Is there room for future expansion?
i.
SURFACE FEATURE CONSIDERATIONS:
Slope:' (1"/1001) "0
.. ....
(Explain)
,en
Flood plain:
Plants:
Roc.ks :
'Y'\. 0
Cut bank or slope:
,~ ,
Low area:
". .~. .
Dr~ir~ge:,a>::
Streams :
WATER'SUPPLY ,AND UTILITI~S:
(SKETCH IN PLOT PLAN)
Community Water: No'
Individual Water: Existing D pr~pos'edI;a
Water lines:,
Ex;i.s,ting D'~ ~~op~s~d D
"
Gas lines:
Existing 'D P~o~os'edD
Wells on,adjacent Existing. D. .Proposed.D
properties:
-,. , ." ..,
.....
. ...~', '
. ;.,. _: .~
'.. .,l.:
-....,
#l'TE S T. .' . .".
H 0', #2 T: T H 0 L E
Perched Water PRO'ILE Perched Water PROFILE
<.
Predicted in. Inch Predicted' Inch
in.
Observed in. ObserVed in.
Date .. " Dat'e
12 -- 12 -
Saturated Zone Saturated Zone
24. 24.
Predicte'd ~L-. Predicted
Observed Observed SL
Date (
Date
. . 36. 36 -
Res'tric.tive Layer in. Restrictive Layer _ in
Impervious Layer - in. 48. Impervious Layer in 48-
Mottling -
in. Mottling in
~........... ';"-t' r; 'c; 1', ~_____-'l....r r: IC""~
60. 60 -
Site Does y' Site Does Not Meet minimum standards for individual.
(
waste disposal.
IF SITE'DOES NOT 'MEET STANDARDS SPECIFY'BAf!S OF DENIAL:
_ Administrative RUles Require -
_ Your .property found to be.Deficient -
.. J
IF SITE MEETS STANDARDS FILL OUT:
Type 'of structure and approximate sewage flow: Single Family
/-
GpD
GPD
r;pD
Multi-family
Connnercial
GpD
.
Industrial
r.pD
Institutional
NOTE: Soil absorbtion area in SQuare feet
Area necessary for sewage disposal systems
JDc>1
I
~
ARE ALTERNATIVE SITE LOCATION, DESIGN OR MODIFlCAT~ON AVAILABLE, DESCRIBE:
~~.
, DATE OF FIELD EVALUATION~'
ffr-~-7S-
NA}!"
\
BUILDING SITE EVALUATION
() BUILDING PERMIT APPLICATION NO.
.
.jS Ie +t- ~UBDI~is. ..
15- ,13
(~ITE INSPECTION
PLANNING DIVISION
Not
Ap!?l icable
A6.T ()
( )
( )
( )
( )
I.
2.
3.
4.
5.
Zoning Ordinance Compliance: Zone
Subdivision Ordinance Compliance
Required Access
Building Site (Area, Width; Frontage)
Other (see comments)
q o-z,
S z.4- TAX LOT 400
APPL I CANT
DATE
LOT:
[k Y\ "i
BLOCK:
No Yes
() P--'6.
( ) (c..j-'
()(~
( ) (4-
( ) ( )
CK'D B'1t:-th-: ~-;ga hE. .
Setbacks fr~c/l road:
Front ~'
S i-tIe-:.. ~ _. : or
Setbacks from interior ,1 ines:
Side IS'
Rea r -zt;)'
C)~ a L-D t~u<~.~.
Ac;.. ~~~,-
COMMENTS:
T.ni.<:'A '-"" ,..,..JL.>'<. ~" ~I" (><< (~l'VI~-r
p~", \"\"1:.. n.A:-.J e,~ \=-.c:,tJ~ ",~,-,<"
PLANNING DIVISION ACTION PENDING: YES( ) NO( } APPLICATION#
BUILDING INSPECTION DIVISION Not
Applicable No Yes
7. Plans Submitted (.{) () TI
8. Soil Stability (footings) (Xl () (
16: ~~~~~ (~:~nconvnei1tS) /J d/l. ~ ~ ~ ~ ~ CK'D By~$~'l/-?j'
COMMENTS: "tJ/a ~~ -A~./-.7z. qMb~~ DATE
cr ( 1/ /j' - -. .. -. / / / 1
/, // :/ c.' ~/ /? ' , /' -
c/~- ..J/Y..l'~ //k.U( ~ ~...-...L.-.L/.A./
/ )
WATER POLUTION CONTROL
Not
Applicable
( )
( )
II. Meets Department of Environmental
Quality Standards.
12. Other (see comments)
COMMENTS:
No ?~
() .
( ) ( )
CK'D
By:,,\lQ o/~/?r
\. J DATE
TO APPLI CANT:
~~Building I Site Inspection:
r11, !;~ :an be approved.
~ () Cannot be approved at this time as indicated on item'NO. above.
.J.,\~~J? Questions and further information on items 1 through 6 contact the LANE-
'17 )\ COUNTY PLANNING DIVISION. Questions and further information on items 7
through 12 contact the LANE COUNTY BUILDING AND SANITATION DIVISION.
( ) Will be held in this office until you can resolve the problems indicated.
( ) Is being returned.
( ) Your building permit applica.!.!.2."_fe",-Ls..beinq..~~t~.m.!l.d under~M.i't.=. cover,
OEPARTMENT Of ENVIRONMtNrAL MANAu~M~N'
135 Sixth Avenue East Eugene Oregon 97401
PHONE: 687-4065
LANE COUNTY PLANNING DIVISION PHONE: 687-4186
C55-28
.-