HomeMy WebLinkAboutPermit Septic Tank 1979-04-19KA-
JEPARTITENT OF ENVIRONMENTAL I'IANAGEMENT
PSB, I25 EAST 8TH AVENUE
EUGENE, OREGON 9740I
Job Address OtZS-rO r-) [Zr>ii$iifYii rRs
ildrii ,S$utl:k:r
App lication for 5t
Affidavit: I,
Structures now on the ProPertY lboe
EPTiLTAI.TU-w.ovA.L--
hereby certify that this information is true and accurate.
for purposes allowed by the State Building Code and
Br,t*.fnffiffi ,:$ rl.'*i$ufiitfiiiltiii riffirlffi
If this
Lane Cou
app
nty
lication is for an agricu
Code Chapter 10 (zoning) and for no
owner of record;
-7-duty authori
Si gnature/Address
Tel
When permit is readY notifY:
0wner
Con trac tor
Contractor's OSR#ffiS
tura bu it wi11 be usedding
r othe r purpose,I have the following 1ega1 interest in the property:
contract purchaser;le
z'l
0r Date
Applicant /-/ &tner 17 Contractor
17
& Phone
Phone 741 "!y: ft nail
fr:c
pnone '7417 -bBat
1S [now] eZgea
ssee; holder of an exclusive option to purchase;
ule of-TfrIT appl ication'
Plumbing by
DU NOT I^IRITE EELOW IHIs L NE
al:# of employees _#i#,#i'ffi,t#*i
l$S.giiiit /_/ Exist'ing, BP # _-____
If Commerci
Residential
S I tes t ho'l es rea OL e.--L. /_-/ Proposed, SI {
fu,.rt,;,+
fiiqflJ-jt+r
,Unit,,Gutti
C'4!\
10n Fee
$
Tota'l Val uati on : $
at
at
I
$
each
each
$
$
Su bto la I
$
/:/
Received by 4% State surcharge
PIans check fee
Change of 0ccupancyProposed _
Year InstaI Ied
PERMIT PROCESSING
Minimum setbacks:
a-t, front
Cornmen
To be typed on permit
Existing _
Tl]TAL $
Part. #
Fire Zone
Parcel #Farcel Size
, side_=_----; int.__-; rear
\--\-a
s-r\
Bv Date
CP&I Type_ Gro Use Cia5l i f ,1'3g rlir__-
To be typed on permi'u
Pr 0a te
Phone
D
I
nformation calI (are.a inspeA,
-I
to si€_-r@.o.lt_-.
For plans i
ti ons
/ SIFO Plans to Da ie
Poqu r red
Hold Siipto PCC
ctor )s
l/ Planning
/-/ PuOlic l,Jorks
/7 Elevation /-/ nla
/-i Address
/:/ Facil i ty Permi t
[/ Envi ronmental Hea lth
FoR INFORIiATI0N about proqress of your app!ication cail
c74-l7L
r.)ir :c
l-cnf,l eted
CP&I
I,iPC
set
set
(s)
(s)
!e to
PC''
/ / CP&l@
Permit Control Cente. 687-HELp rc87-4357)
+- |Q-zQ
CI
:St$Er*:nttrutrrr
6
$tlater supply \ t r. " Cr \--
#T TEST. HOLE
PROF]LE FILE
Inch Inch
*aPl
uk
L2
24
36
48
$.
60
361
L2-
24-
60
48-
PREDICTED WATER
SATURATED ZONE
trictive Layer.Alfur(,
ervious L^ygrlUn
tling Vff in
1n
1n
Date
1n
1n
SLOPE lo
Predicted
rved
redicted
ate
served
S
t
SATURATED ZONE
Restrictive Layef-
Impervious Laye
SLOPE
Ln
&kr
n
inl
]-II r
1n
PERCHED WATER
Mottling
Predicted
Observed
Date
Predicted
Observed
Date
K
sr# -71- 3/&
SITE DOES DOES NOT MEET MINIMIIM STAI{DARDS.
ADMINISTRAgIVE RULES PdQUIRE A MINIMI]M DEPTH OF:
36 inches t,o an imperrneable layer
30 inches to a restrictive layer
60 inches Eo a permanent water table
24 inches to a temporarily perched water table
#z EST HOLE
ON YOUR PROPERTY THE DEPTH
VIAS:
inches
inches
inches
inches
OTHER REASONS FOR DENIAL
PLOT PLAN:
Stream
--i-\.fr-
Drainage or
pond
Road
:test Hole @
\ % SloPe
Cut Bank
.f t rrr
Fence
N
tl- X-X
T
tr
tr
tr
,,4
br*
W
-a6'b 4 10-V-Al3
747896/
TRS, TL
Subdivision
Lo t B lock
--SITE FEAS!
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS
Job Locati
Written Directions
ILITY REPO FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
Phone
Phone-
Mail report to J/applicant ( ) Owner
RUCTURES NOW ON THE PROPERTY
) Prefer to pick up. Call (owner, etc.) when ready
d
PT.yPOSED USE OF PROPER
WATER SUPPLY WITHIN ONE MILE OF THE CITY OF (No)_
I hereby certify that the above statements are true and accrlrate, and that I havo tho tollowing legal interest in the property:
-
owner oI re@rd;
-
contract purchaser;
-
potential buyer;
-
.ealtor or Aent, I furthor cortily that {iI not tho owner) I am authorized to act ,or the owner o,
record, and that said
TEST HOLES READ
and approves of this action.br-or/rs
p,/ Signature orr" '/-/?'? 7
******tt******* * * * * * * * * * * * *OFFICE USE ONLY BELOW THIS LINE * * * * * * * * * * * * * * * r( .r+ * + * * * * * * * +
SITE NDARDS.
aa/
E PLIANCE
-/f-"ul fu
Zoning
Acreage or Lot Size (TOTAL)
( ) Completed( ) Pending
AUTHOR IZED N RE DATE
Di vrslon of Water Pollution Control
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
c55-32
Partitioning
Parcel #-4?a__2
.# -<rr.*- -+*
AUTHORIZED NATURE
Permit Processing Section
-u4*- ,rrrr{
*\.04-/ r
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERI\4IT. ANY PLANS OR EXPENDI.
TUBES MADE IN RELIANCE UPON THIS REPOFT ARE AT YOUE OWN 8ISK. IF SITE IS APPROVED, SEE REVERSE SIDE.
{-e{-7 7
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
\a d'il12
I
rEr \
)
OAR Chapter 340, Division 7, Section 72-020(61: This report shall remain in effect 0ntil 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 willappear on the permit.
lf the property is only a portion of a'tdx 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)
iI-
SITE EVALUATION WORKSHEET
rwp. la RAlrcE_2-_ sECrroN----=36_ rAx Lor #2n
PROPOSED USE:.s"F6_
LOCATION:
ZONING:
SIZE OF PROPERTY:
WATER SUPPLY: COMMIJNITY
SUBD I VI S ION/PART IT I ON
AMOIJNT US$LE AREA: t{E/)
PUBLIG INDIVIDUAL IK
LOT BLOCK PARCEL
Single Family
Industrial
Ins titutional
IF SITE IMETS STANDARDS FILL OUT:
Type of structure and approximate sewage flow:
l,Iul ti-f amily
Corunercial
cpd
8pd
MINIMUM DESIGN REQUIREMENTS :
Length of disposal trench required
cpd
8Pd
8pd
/150 gal.
Distribution Method: Equal
Curtain drain required: Yes
Other:
E lEaIrt-Se
No
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
NAME:4 Q,^z
c74-126
c DATE OF EVALUATION:ir/-a/-2a
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