HomeMy WebLinkAboutPermit Building 1978-10-10c *40 s.l. #
TFS, ] L l1 Job Location
Block
SITE FEASIBILITY BEPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
Written Directions
Subdivision
Lot
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS
Phone--
Phone-
WATER SUPPLY
I hereby certify that the above statements are true and accurate, and that
contract purchaser; potential buyer; realtor or agent.
record, and that said owner is aware and approves of this action.
WITHIN ONE MILE OF THE CITY OF (NO
lhave the following legal interest in the property:
-owner
of record;
I further certify that (if not the owner) I am authorized to act for the owner of
TEST HOLES READY Sign ature Date
SITE: f] MEETS STATE STANDARDS E DOES NOT IVIEET STATE STANDARDS LAND USE COMPLIANCE
Zoning
Acreage or Lot Size (TOTAL)
Partitioning ( ) Completed( ) Pending
Parcel #
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THIS IS A PRELIIMINABY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PEBMIT, ANY PLANS OR EXPENDi.
TURES I\4ADE IN RELIANCE UPON THIS REPORT ARE AT YOUB OWN RISK. IF SITE IS APPROVED, SEE REVERSE SIDE.
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AUTHORIZED SIGNATURE DATE
Division of Water Pollution Control
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
c55-32
AUTHORIZEO SIGNATURE
Permit Processing Section
DATE
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
3.
,E rt
Mail reportto ( ) Applicant ( ) owner ( ) Prefer to pick up. call _-''. -- (owner. etc.) when ready.
PROPOSED USE OF PROPERTY
-
* * * oFFtcE usE oNLy BELOW TH|S L|NE * + r
OAR Chapter 340, Division 7, Section 72-02016l: 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 disposalsystem will appear 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.
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f/1 TEST }I OLE /IZ TEST HOLE
PERCHED WATER PROFILE PREDICTED WATER PROFILE
I're dic Ce d
Obse rvcd
Dat,e
ln
IN
Inclr Predic ted
Observed
Date
,1n.
Ifl o
Inch
12
24
36
48
60
e/u,12
SA'I'tJRATIiD ZON!]SATURATED ZONE
Predicted
Obse rved
Date
L Oettl1n redicte d 1n
Ln
241nse rved
teto
36
&0Restrictive Layer tfr,..e in
Lnpervious Laye r Nu*+ in
I'lo1 Iling t\**ih 86-rn
stricti ve Laye r _ins Layer _in.mperviou
48ttlingln
SLOPE FI"{ %SLOPE a/60
XSITE DOES DOES NOT }.1EET I'IIN II'ITJM STANDARDS.
ADMINISTRATIVE RULES REOUIRE A I,IINIMI.JM DEPTH OF:
36 inches to an impermeable layer
30 inches to a rescrict,ive Iayer
60 inches to a permanent water table
24 inches to a temporarily perched $/ater Cable
OTHER REASONS FOR DENIAL
sr# 7&- Ft z I
ON YOUR PROPERTY THE DEPTH
I.trAS:
inches
inches
inches
inches
PLOT PLAN:
S Lrc anr
-a.rr/f.ffr
Drainage or
p<lnd
Road
----
S.. ?L+ M^p to/ 5
Test Hc,fe @
\ % SIoPe
Cut Bank
//, {7-7-
i"cnce
x-x
u
sr# 7{ -7t2
LOCATION: TWP.
SlE EVAIUATIO\ WORKSHEET
SECTION /7
PROPOSED USE;
CJ/7 RANGE TAX LAT #
ZONtrNG:RA RrrO
/0o0ou7fl.tSlZ}i OI' PROI'ERTY:
WATER SUPPLY: COMMUNITY
Itulti-family
Conrnerc ia 1
SUBDIVISION/PARTiTION 6/en,Ion IcT"S TOT 5 .BLOCK-PARCEL-
IF SITE MEETS STA}IDARDS FILL OUT:
Type of structure and approximate sewage flow:
AMOUNT USA.tsLE AREA:4ll
Single Family
Indu s trla I
Insritutional
tso
Bpd
cPd
spd//U,",
gpd
8pd
MINIMUM DESIGN REQUIREMENTS :
Length of disposal trench required
Distribution Mechod:
CurLain drain required:
Orhe r :
Lfo tu or 75 lno*/ fl'lLSo gar.
Equal f,J SeriaI
No ^8.Yes
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
DATE OF EVALUATION:ttr/",/ 74
NAME:
duc
Coa pitl c
c7 4-L26
StJon 7{
PUBLTc tf TNDTvTDUAL |-]tr
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
f,
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(AVERAGE PROCESSINGPI.ANNINC DIVISION
Partttlonlng I
Parccl No._
Partltionlno Raoulred
Current Zon
lnenclins f]Compteted
Other t
NATEN POLLUTION CONTROL
llGv Sltc Inapectlon(e)
sDS Con.tructlon lJ Ney
Nunb€r of Bedroornsr
Conrrarclal,/Industrlal -
Othor
[-l nepalr
I of Employeee
I o( Sltea ocu,(,.
H
Ho
€u
an
bio
rlHo,,>t
Hoz
CONSTRUCTION PERHITS AND INSPECTION(Seo abovc lor I of bedrooms,/l of enp
tl :{obttr Homo
n permanent
f-'l TcmDorarv
t] RenewalStructura Sq. Pt. Val tlon
FEE
e)
s
Total, Vlluntion
. Plumbing fixtures at
_ Sewernater Conn. at
{t St6t. Surcharg.
Plana Check Fec
Change of Occupancy
ltlnlmul atructural,
FroE cent€rlinc ol
Froo lnt€rlor I
f] conrm'l plans
PUBLIC IANDS.
PUBLIC I{ORI(S
EMVI HEALTH
Ch.cL
Subtota I
rOTAL BUILDING PERHIT FEE
reeL: Front
Exterior Sld€--
ines: Side_ Rear
haet to appllcant I CurU cut to appllc.nt
Address t] Minlmum Elevation
Pacillty permit
5
E
6)
trl
oi,
$
I
Each S
Each 3
D
tlf]ft
Ca.h Rac'd by 1 TOTAI, S
; or that the osner of record ls
AFFIDAVIT: ,rf thic Pernlt is for an agrlcultural buildlng, I hereby declrre th.t thls buildlngwlll be used for agricultural purposes as allowed by zoning and/ot ihe state Building code, andfor no other purpose. I further certify that the siatemcnia and other information submltted oathla application are true and accurate, and that I have the folloulng legal interest ln theProPerty: _otmer_of record; _cont.ract purchaaer; _Ieesee; _holder of an exclurive optlonto purchase;
-duly
authorlzetf-to act for a person wE6-hag the fdTlowing legal lntereet:
appl lcatlon,if I am not the ovrner. I further ag
of thisith al lc Le coder relatlng
6FprApplicant'a Signatur
THIS IS YOUR RECEIPT, AND DOES.NOT GIVE YOU PERIT,IISSION TO BUILD.
tOR TNTORXATION ABOUI TIIE PROGRESS OP '' ''R APPLICATION, CALL PERUIT CONTROL, 68:
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Address
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lmum Elevation
7 (687-HELP)
hne county
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to thls perrfllt. ,D.r. g/ 2t/74
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