HomeMy WebLinkAboutPermit Building 1992-01-28SEWAGE DISPOSAL SITE EVALUATION %zz
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Written Directions l+q;^Rb tb Pfteagaat Bcr,, D T6 6l.k DaL&
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[trrb 8*qs t t LLt<uq ,l rLekAPPLICANT'S NAME AND -crx) o
OWNEF'S NAitE AND ADDnESS o^.,n e phon._
STRUCTURES NOW ON THE ry€PROPOSED USE OF PROPERTY Setu^teL - D "0 lex
I hereby certity that the above statements are true and accurate, and that I have the following legal interest in the property:
-owner
ol purchaser; ,y'oolential buyer;
realtor or agent. I turther that (if not the I am authorized to act for the owner of record, and that said aware and aclion
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" " "" " ""'-. oFFrcE usE oNLY BELOW TH|S L[{E ......
Tt- r'HOLES READY
SITE MEETS STATE STANDARDS
Standard System
Sand Filter
1 Foot Capping Fill
NO
tr
n
tr
YES
a
tr
tr
YES NO
tr
D
tr
Low Pressure Distribution
Holding Tank
Other
tr
tr
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LAND USE COMPLIANCE
Zoning--____-________ AcreageorLotS|z6_CTOTAL)
Partitioning #-Parcel ) Completed
) Pending
FLO'ODPLAIN I NFORMATI ON
tr Approximate
Study Area
tr Detailed
Study Area
! Floodway
All or part of this site may be in a flood hazard
area for which 100 year flood levols have not
been ostablished. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part ol this site may be in a flood hazard
area for which 100 year flood levels have been
established. A building elevation above the 10o
year flood level may be required.
All or part ol this site may be in a flood hazard
area in which a floodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative etfect of
proposed development will not increase the
100 year flood lovel at any point.
THIS IS A PRELIMINARY REPORT WHlCH 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./-)2r>
DTtrE
LANE COUNTY ENVIRONMEN HEALTH, r?5 EAST 8TH AVENUE, EUGENE, oREGoN 97401 (687-4051)
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 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 void this report.
WARNING: This document is a technical report for on-site sewage disposal only. lt 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 ol 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
eadier 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
automatically benefit subsequent owners.
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 owner or contract purchaser or his regular employees may install subsurface sewage disposal systems.
A certificate o, satisfactory completion will not be issued if persons other than the above perform the installation.
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STTE SVALUATIOI..I IIE.D HORKSIIEET S. I - J3e
Tax ftefer.ence
AppIl-cant Date:
Zon i og:
-Part.rcel#k-t
__Ut..,.- Parcel Size:_________!ater Supply: t.rel I Comuni ty public
Depth Texture
Soil- uat.rix Color and r.lott].ing (Notation), tcoarse Eraguencs, qoots,
Struct::re" Iayer Lijui.ting Eff,ective Soil DePth. etc-
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SISTE.' SPECf,I.ICArIO}{S
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neplaceoect
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Sysc€a slzlna
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1{t*,I 8. !1ax- Depth Absor?tion Faciliry (in)
50 g. Max. oeprh Absorpcj.on Facil:--y (in)
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Special CondiLlons
PLOT A.AX Oi{ REVBSE SDE
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The Lane County Building and Sanitation Division cannot proceed with processing your application because:
lncomplete application (items deficient).
tr Address and/or directions to application site.
tr Proposed number of bedrooms in dwelling.
Approvable plot plan (see attachment).
Notification of date test holes will be ready.K / M.{L *-* .,""rrryffiir*
Verification of existing system required (see attachment).
Two test holes (2'x4'x5'deep) required for expansion or repair of existing sewage disposal
system in the area of the proposed drainfields.
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SIG DATErtoE fr-b 7
PHONE
from
OFFICE HOURS
. 1l no response has been received in regards to this matter Oy t - - 7 O .- \ ,the application will be denied.
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
Courthouse-Public Service Bldg. / 125 E.8th Ave. / Eugene, OR 97401 t 687-4501
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APPLICATION
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The Lane County Building and Sanitation Division cannot proceed with processing your application because:
'1. ts lncomplete application (items deficient).
Address and/or directions to application site.
Proposed number of bedrooms in dwelling.
tr Approvable plot plan (see attachment).
tr Notification of date test holes will be ready.
2. I Verification of existing system required (see attachment).
3. tr Two test holes (2'x4'x5'deep) required for expansion or repair of existing sewage disposal
system in the area of the proposed drainfields.
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OFFICE HOURS
DATE
h^to from
PHONE
lf no response has been received in regards to this matter
the application will be denied
/-J0-17
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
Courthouse-Public Service Bldg. / 125 E.8th Ave. / Eugene, OR 97401 I 687-4501
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