HomeMy WebLinkAboutPermit Septic Tank 1976-6-1
CONSTRUCTION
I=:J OWNER
~TRACTOR
O,S, REG, II
------=-----
NOTE:
LANE cnUNTY SP
EClAL PERMJ.Td.RE&
NO PERMIT WILL nil ISSUED UNTIL THIS APPLICATION "nS
PERMIT IF IIJ? P-?6
BEEN APPROVED
./' APPLICATION FOR:
CE:S MOBILE HOME I=:J PLAN REVIEW C:=J
CiUU~GE OF OCCUPANCY
c:J
Name
Address
Phone
City
Zip
Rn L(
NameJ
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Address City
'17~?'7 ?q6 -/6?f
Zip Phone,
,
~Ib
Tax Lot 1lJ.?
Code /9.-(;)1 Census Tract -W-j ~
Twp, /? Range O? Section ;2'/-' <'j /
Subdiv'ision iY\ 1-1," -1 \0 Lot . \
, . AJI ;E-. rr~ ^
ACCESS TO PROPERTY (Road Namef,- ""L.~" ._~-
Existing Structures on Property: ~t'J1~
Property Locatio~ - Address/Directio~ \
Off Nfl. /'J -I.,. Ih' ~r?r/~l{'.---e/d ~ "J/..dr, , l3rr~/ 12c::t. At'>! FQ'<f-.h A/h'- :28'f1..
r9rf.3P c5J;fU ~/9'7 V?i
Below fo r Off ice Use Onl vxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxt0UCXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
St/?~ (i)yJ. eo t~o) ,~aooZ7. (1)
Olc2x;) S. ")K " - - . ;2' h X /, l?D
/
'-II, 7{..r,;<0
~r New System Required ~
Name of Community or Public System t?a/~ bor.J
Block
Width______Depth
Property Acreage
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SEWAGE DISPOSAL,
Site Inspection #
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WATER SUPPLY:
Well
FEES:
Bldg,
Plumbing
3 % Surcharge
Waste Disp.
Plan Review
Mobile Home
\ TOTAL
IANF 1I1IINTV '30=C~:'.l r{::"i~:"'_~Ki:d.,
Existin~ Sewage Disposal S ste~ ~
Spring
Other
Sewage
Connection
Public
D<6
Name
I
Wa/0/\
1(, <. --
3 <.j, -
<.ql
7C" '
J~ --
PLUMBING:
Installed 1y Owner
'"-,~ ",
(0 \ II
Other
6(
Water
Connection
.2
02 7"Z!l/-
PLANS FURNISHED FACILITY PERMIT
L......:::::f -;;; C:=J. NO ~S c::=J NO
Signature of APPlicanV(~a...tAJ lA 9,.,)".,.Jh_
Fee Received By: G ~,t;;PtJ Date'_ ;~//r7h
-O=--;-a- -/./
Drainfield Required - Lineal, Feet ISO Maximum Depth ..:JC
::rL';/ ~""4'fl, ~/, ~nJ~ """"'--F2A.a.... ~
'Up./) , 7 '- /- r ....:::: Jt!';;-,"Ii 11
!-7 ~~ (0 p"'- ,~a<. / ~"'W n.-. ~
c::=J CASH
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M~ Septic Tank Capacity ~~
\ zZd ft"Yit</P"A_-
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(, 4' I
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~pe of Construction
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a.dg Setbacks -
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ront~
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. CSS-12
-
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Group_lc.tJ" ::I_Fire Zone
Use Classification
from Center of Road Right of Way:
Side In t. .c;,,' Side-Exterior
~'
4$,'
Zone 1:3,h..
Rear
I' DATE: / SANITATI<1:
VJ ~/-7 fJ ...4lfO ~_,
, ~E COUN~ DEPARTME4 OF
DATE: /J !Pf!JUJING:
_\-.N<7?; rl'~~;f'
ENVIRONMENTAL ~NAGEMENT ' }I
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~ATE:
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Job Location
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S!",r.!"l:r'-ip~ d ')r~pon 07:177
\t~_,~('r.""'r1 'Pi..-fl,rtv ,.~,-
SITE FEASIBI L1TY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
17n x :''In
( V.;6mpleted
( V) Pending
.~a-=-v:iT1
APPLICANT'S NAME AND ADDRESC::
Acreage or Lot Si7a
p :,nn~ 17
Partitioning #
Subdivision:
) Would like to meet on site, Call
Lot
Block
~fcI.elin 2(,5'5 H"vden llridl?e RJ
,Viail report to ( ::)~ Applicant (
) Owner
~~rin~fie1d Qre~on
;-
;
j~
) Prefer to pick up, Call / ,(owner, etc,) when ready,
Existinr Structure'~rtition Pending on Prnnertv
n"e11in" Sire /'
Sa~e
Phone
Phone
'':'/.7-11231
OWNER'S NAME AND ADDRFC::C::
/
STRUCTURES NOW ON THE PROPERTY
PROPOSED USE OF PROPERTY
WATER SUPPLY, Prnoos€c1
~
NeF
SITE: ~,MEETSSTATESTANDARDS DDOESNOT
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ZON'iNr: \..~-\ L'/. ~.<'Y' c. HI --, '7
B'y ~v, ( c .y~, Date ~ \\...:J. \,\ y '\ - AUTHORIZED SIGNA'[5E' - DATE
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PLANS OR EXPENDI.
TURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK, IF SITE IS APPROVED, SEE REVERSE SIDE,
PERTY IS WITHIN ONE MI LE OF THE CITY OF
~DT.r.,...n.,':';r' "
I' hereby certify that the above statements are true and accurate, and
contract purchaser; _potential buyer; _ realtor or agen
record, and that said owner is aware and approves of tnis action,
TEST HOLES REA6Y- d--.l "no '- lo..) \
*.. * ** **.. ** * **.... ** *.... * **.... ** * * *.. *.. **.. * * ** * * * 0 i\f I C~
at I have the following legal interest in the property: Vv owner of record;
further certify that (if not the owner) I am authorized to :'ct for the owner of
Signa'hir~~, ~', :'\--,~", . Date ~--:::: \. \ r' \. ' " \
SE ONLY BELOW THIS-LINE ***********************************'***.IHl'***
T STATE STANDARDS,
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C55,32
LANE COUNTY DEPARTMENT OF
ENVIRONMENTAL MANAGEMENT
Division of Water Pollution Control
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
687 -4061
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OAR Chapter 340, Division 7, Section 72,020(6): This report shall remain in effect until issuance of a
permit to construct, unless in the meantime conditions on this or adjacent properties have been altered in
any manner which would prohibit issuance of a permit, in which case this evaluation report shall be con.
sidered null and void, Technical rule changes will not invalidate any evaluation report issued pursuant to
this section,
Before construction is started bring this form to the Department of Environmental Management and apply
for a building permit, Exact specifications for the sewage disposal system will appear on the permit.
If the property is only a portion of a tax lot, a partitioning or subdivision must be approved before the
permit will be issued,
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,
P~TI'l'tONER:i:~m~!"C
~~ne countx ',~
NAME:
-:) ~
. ),Ji~.i. '7.u.~'k' {. .(;/.~~'\ )l' Ct-'1'/u '.1) .,';' . /11 ( :r.. QI.t/JLc
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ADDllliSS :,) {. S S ';-I,,/,t~'"'_ ,Cl",-,'f-,V f(l},
PHONE:
CJ '7. r (J'
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INTEREST IN PROPERTY:", ,'OAA'-;"i/'~"
(f:ndica~e~ bn.e: ; ,owner:, contract purchaser,
, option holder" other)
, IVATER SUPPLY:
PERNIT II:
SElVAGE DISPOSAL:
S,1.II:
ELECTRIC SERVICE:
WNING:,
/!;liJfAd( .k.-1.i.> LU'o.~:l_ JJ I't"~J(
,OWNER OF, RECORD:
f 1<;; L A
K- /
PHONE:
)17i""L'~~'-' E (,-",,,ilm(l>.~i I)}, :i:,~,_ r-;---":
'J' ,0 P ", fii ' . DATE SUBHITTED:
~I L SS /'< o./'t"u""" r0"",c...'- il. ,! "II,' RECEIVED BY:
S" /-L-t"'.,/!,;,,pI ' [171/7;7 , I FEE PAID:
'7'1"/ ci.) Y (J
.J . i'- J \ " ,.) J -:"1.....1
HEARING, DATE:" ....)v.r\\..('. ~,l , ,. \.
10D '" " i TO., . .,~;~ roval _ _ fO:~',':::::_:,:':,_ __._ __C.;~'
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ADDRESS:
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TAX LOT:
BY:
Acting Chairman, Land Development' Review Committee
Date
vicinity
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PLANNING DIVISION
C14-15
ENVIRONMENTAL MAI,AGEMENT DEr,~RTMENT / 135 EAST liT1'1 AVE, / EUGENE, OR 97401 / PHONE (5031 687,4186
Sheet I of 2
SITE EVALUATION WORKSHEET
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LOCATION:
TWP.
17
RANGE
<83
SECTION..Lt/ c/ ' TAX LOT # . /!YO
<0 . . ~.~.> /~L. clu}f/l~
,{/ {/ Uc (/
AMOUNT USABLE AREA: A~~,~
PUBLIC 1---1
INDIVIDUAL II
ZONING:
~
PROPOSED USE:
SIZE OF PROPERTY:
no'x~1
WATER SUPPLY:
COMMUNITY GZ1
IF SITE MEETS STANDARDS FILL OUT:
Type of structure and approximate sewage flow: Single Family ,~
Multi-family gpd Industrial
Connnercial gpd Institutional
gpd
gpd
gpd
MINIMUM DESIGN REQUIREMENTS:
Length of disposal trench required
Curtain drain required:
Othe r:
Equa 1 I;Z::2
Yes 0
1M) ~ ~
, V V
Serial D
No ~
/150 gal.
',Distribution Method:
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
NAME:
J AA=-
U
DATE OF EVALUATION:
::s-~,'{-77
C74-l26
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----..
# 1 T E S T .. 0 L E # 2 S T H 0 L E
PERCHED WATER PROFILE PREDICTED WATER PROFIUE
,Predicted in. "Inch Predic'ted in. Inch
Observed in. Observed in.
Date :;;~ Date
12 - 12-
SATURATED ZONE SATURATED ZONE
Predicted in. 24- Predicted in, 24 -
Observed in. 5~~ Observed in,
Date Date
36 _ LJ)fi1Y" /'
36-
Restrictive Layer in. Restrictive Layer in
. Impervious Layer in. 48 ~ Impervious Laye'r in 48
-
Mottling in. Mottling in
60 60 -
(
.
..
..::=--
SITE DOES .'fbJ DOES NOT 0 MEET MINIMUM STANDARDS.
ADMINISTRATIVE RULES REOUlRE A MINIMUM DEPTH OF:
ON YOUR PROPERTY THE ,DEPTH
WAS:
'0 36 inches to an impermeable layer
O' 30 inches' to a. restrictive layer
'0 60 inches ,to a permanent water table
c=J 24 inches to a temporarily perched water table
OTHER REASONS FOR DENIAL
, PLOT' PLAN :
--
Stream ,.
----
Drainage or.'
pond
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Road
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Test Hole 4D
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Cut Ban\<
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inches
inches
inches
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SCALE: /,~.: /O,:,?- FILE 'NO:
Pli\NNI~IG DIVISION I EN~/.IRONMENT^L w',ANAGEMENT DEPARTMENT'l 13!; EAST 6TH AVE, I EUGENE, OR 97401 I PHONE (503)' G8l,~ I
Sheet 2 of 2
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DATE,
(BLDG. PERMIT NO.
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