HomeMy WebLinkAboutPermit Building 1979-07-0270s.l. #
Job Location
Written Directions
Lot- Block
SITE FEASIBILTTY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
APPLICANT'S NAME AND ADDRESS LO
OWNER'S NAME AND ADDRESS
0()Prefer to pick up. Call
rR\,iL/?-?3i-?3.3. ? t e0O
Subdivision
Mail reportto ()Applicant ( )Owner
^TRUCTURES NOW ON THE PROPERTY
PROPOSED USE OF PROPERTY
WATER SUPPLY
I hereby certify that the above nts are true and accurate, and that
contract purchaser; potential buyer; realtor or agent.
of this
enonQ-f$--2.3!1$
Phone
-
(owner, etc.) when ready.
WITHIN ONE MILE OF THE CITY OF (NO)--
legal interest in the property: owner of record;
record, and that said owner is aware and *l)actioru. zau,a-11&
TEST HOLES READ UL:A
J( * * * * * * * * * * * * * * * + * * * * * * * * * *Qf f ICE USE ONLY BELOW THIS LINE * * * * + r+ * * + * * ***************
LAN COMPLIANCE
Zoning
Acreage or Lot
Partitioning
Parcel #
-
(TOTAL)
RE BUILD ING PERMIT. ANY PLANS OR EXPENDI-
TURES NNADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK. IF SITE IS APPROVED, SEE REVERSE SIDE
IGNATUBE
it Processing Section
( ) Completed( )Pending
DATE
/./'?--o* ill
>{Z 4,a,A -/7--7auiffiEz6tffiiUnel/
Division of Water Pollution Control
LANE COUNTY DEPARTMENT OF ENVIRONN4ENTAL MANAGEMENT
c55-32
)tWzr AUTHORI
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
certify that {if not the owner) I am authorized to act for the owner of
Date
fr
7/^/n
I
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 evaluition report isued pursuant to
this section.
Before construction is started bring this form to the Department of Environmental Management and apply
fora building permit. Exact specificationsforthe sewage disposalsystem willappear on the permit.
lf 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 Ouality under ORS 454.695
to install subsurface sewage disposal systems or an owneror 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.
I
(
SITE EVAIUATION WORKSHEET
LOCATION: TWP. /? RANGE O J sECrroN 23 ,3
ZONING:PROPOSED USE:s.il)
SIZE OF PROPERTY:AMOIJNT US$LE AREA:
Z-rs. Lor #)4<
WATER SUPPLY:GOMMIJNITY PUBLIC
SUBDI VI S ION/PART IT ION
IF SITE I{EETS STANDARDS FILL OUT:
Type of structure and approxlmate sewage flow:
M-r 1t i-f ami ly
Conrnercial
MIN]MUM DESIGN REQUIREMENTS :
Length of disposal trench required
E-
LOT BLOCK PARCEL
Single Family
Industrial
gpd
8pd
cPd
8pd
cpd Ins titutional
Ao.rce#/750 gaL.
Distribution Method: Equal
Curtain drain required: Yes
Other:
re I (.,i^t f.]NoE
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
&)4-
NAI'IE:g.-4a.--
c74-L26
7:a DATE OF EVALUATION:
-,n L0- "? - 3?o
/
TNDTVTDUAL l_]ll
tl
PROFILE PROFILE
Lnch Lnch
5,t'pfrw
h"A/4
LdW
gr
tz4
24-
36-
48-
60-
PERCHED WATER
SATURATED ZONE
Restrictive Layer a
a
III r
]-fl r
SLOPE
1
].,n
/o
us Laye r
1fI r
1n
Predicted
0bserved
Date
Predicted
Observed
Date
Impervio
Mottling
1,2.
24-
36-
60
(0.
48-
PREDICTED WATER
SATURATED ZONE
strictive Layer _inImpervious Layer in
.fI o
Ifl r
ate
SLOPE
1n
,n
o/
lo
1nttling
redicted
served
Predicted
Observed
Date
DOES NOT MEET MINIMI]M STA}TDARDS.
ADMINISTRATIVE RULES REOUIRN A MINIMIIM DEPTH OF:
36 inches Eo an impermeable layer
30 inches E.o a restrictive layer
60 inches to a perrnanent, water table
24 inches to a temporarily perched water table
OTHER REASONS FOR DENIAI
sI# LC 77-SZo
#z f-nsr HoLE
oN YOUR PROPERgY THn pEPTH
tr{AS:
inches
inches
inches
inches
#T TEST -f,OLE
SITE DOES
PLOT PI,AN:
Stream
-.^rhri..Lt-Drainage or
pond
la..ta.aaar.alata
Road
-_--
rest Hole @
\ % SloPe
Cut Bank
a77777'
Fence
)(- X-X
T
tr
tr
tr
ffir/e4€,tu
DEPARTIiENT OF ENVIRON14Ei.ITAL IlANAGEI"lENT
PSB, I25 EAST BTH AVENUE
EUGENI, OREGON 9740]
Ci ty
Appl ication #
/7 Assigned NumbersJob Address
Township, Range,ection, Tax Lot
Subdivision
Appl ication for
Structures now on the proper
Proposed use of property: la7 Residential / Commercial
Affi dav i t: I ,
'7
Lot __-'- Block
{-
I ndu triaI / Publ i
\
S c
n
If this application is for an a9r cultural building it vril I be used
Lane County Code Chapter 10 zon i ng
owner of record;
hereby certify that this information is true and accurate
for purposes allowed by the State Building Code and
e
) and for no other purpose.I have the following 1ega1 interest in the property:
I essee;holder of an exclusive option to purchase;rchaser;contract pu
to act for the owner---- duly authorized
Signature/Address fit
Te1 epho
When permit is ready notify:Appl icant /_/
, who is [nowle?geable of-tfrIs application
0r
/_-/ Contractor ry_
z1
Da te
/-/ ma phone
y,2Owner
Con trac tor
Contractor's 0SR#
If Commercial: # of stories
Residential: # of bedrooms
Plumbing by
# of employees # of units
SDS: /l Exi sti ng , BP #
z
Pho ne
J
*,irttFee
Code
SI test holes ready
Descri ption
Sq.#of Val uati on Fee ,o
$
*/6.rr
Total Valuation:
P1 umbing fixtures at
Sewer/water conn. at
4% State surcharge
Plans check fee
Change of 0ccupancy
$$
$--
$
Subtota l
TOTAL
$--
$_-__ -
$
each
eachl-/ Cash
/-/ cnec
Rece i ved
k#
$---
$Water Supply
Proposed _
Year Instal led
Exi sting _$--__-
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4 CHUCK BAILEY, ARCHITECT
tzlo wi[ualaETTE srREET, EUGE-ryE, oREG(t '- 485-33rs 97401
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CHUCK BAILEY, ARCHITECT
tZlO WILLcMETTE STREET, EUGENE, OREGON
485-3315 97401
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Pollution
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Con 'rsioo
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FILE NO:SCAIE
PLANNING DIVISION / ENVIRONMENTALMANAGEMENTDEPARTMENT / l25EAST8THAVE. / EUGENE,OR97401 / PHONE(503)687.4186
B
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lone county
HOLD SLIP 6l\'!I7APPLICATION #
Name
Addre s s
Zip Code
The Lane County Water Pollution Control Division cannot proceed
with processing your application because:
l. Incomp'lete appl ication ( items deficient).
Address and/or directions to application site.
Proposed Number of bedrooms in dwel 1 ing.
Approvab'le plot plan (see attachment).
Not'ification of date test holes will be ready.
2. Verification of existing system required (memorandum
explaining this procedure attached).
3. Two test holes (2'X4'X5'deep) required for expansion
or repair of existing sewage disposal system in the
area of the proposed drainfields.
4. 0ther:
M74 - 181
WATER POLLUTION CONTROL DIVISION /I25 EAST Bth AVENUE / PUBLIC SERVICE BUILD1NG
ENVIRONMENTAL MANAGEMENT DEP/ EUGENE, OREGON 9740I
ARTI\,IENT
687-406 I
0p 62? -71 4,-
DEPARTIIENT OF ENVIRONI4ENTAL I,IANAGEMENT
PSB, 'I25 EAST 8TH AVENUE
EUGENE, OREGON 9740I
Job Address
on the property
tion is for an agr cul tura bu
e Chapter 10 (zoning) and for nof record;co
au thor to act tor
8/ liBg.*tiusf itifi .tri.ii L-l i$ffiCIs,il'{ijfrii; /:/
7
rl[stiii'.&tritii:ki_
/_/
hereby certify that this information is true and accurate
t7-o3- a3.3.>.,S,rx*t 5lPvr. /
+ 20n
Appl ication for
Structures now ,
Affidavi t: I,
If this applica
Lane County Cod
z OwIl€l---y'-auly
lding it will be used for purpos
o other purpose. I have the fol
ha ser;es see ;
who is n0w le o
0r
Owner /-/ Con
es allowed by the State Building Code an
lowing legal interest in the pro perty:
pu rchaseolder of an exclusive option to
I ication
Da te
!a: /-/ mail phone
z1
z'l Phone
d
hr
r-TFTs app
Si gnature/Address
Te1 ephon
When permi i s ready i fv:
0vlner
*
Contractor's 0SR#
I icant
Plumbing by
DO NOT WRITE THIS LINE
If Conrnercial
Residentia'l :
# of employees .*;::::nf :t::lttt;itt,r,:.:
,i$$.$r:;:ii l_l Existins, BP #
:t:riacl:iEffi
SI test holes ready
Ue$firi:sttui:ii.
fi\aa*or\
Fee ,v
$
$
Total Valuation: $$
/_t */6{
&
Rece i ved
lJater Supply
Proposed _
Year Instal led
4% State surcharge
Plans check fee
Change of Occupancy
at $--
at$
Su btota 1
TOTAL
each
each
$
$
$
$
$
$
$
(-r)otlr-zlExi sti ng
7"d 4
.-'7 ,,
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Vaiuation
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ENV },IGT BECEIFT O
DATE O3O87? TAXL(
SUBDIYISION
NEUI BtDS TYPE US6 R NS ENRH$ O? tIO UNITS O$t N$ STORIES
NODI APTbL ilO ACTIO}.I DE$flRXPTION Sfr F'T UNIT OS$T VALUAT]
NCI. FIXTUBES:NO. CONNHCI'OR.I ;
MECHANItrAL FEE
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FLAN CHfiCH FEE T}flI ?:i,oQ
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SIFO CFI T,IFC PLAH ELEV ADDE FF
CCIilPLETED BY
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