HomeMy WebLinkAboutPermit Septic Tank 1979-04-26TRS, T
Subdivision
Lot- Block
APPLICANT'S NAME AND ADDRESS
OWNER'S NAME AND ADDRESS
,. -ll ,"por, to ( ) Applicant ( ) Owner
STRUCTURES NOW ON THE PROPERTY
()Q Prefer to pick up. Call
s.l. #7
,l-t Phone -y8
enone 74 7-P86/
(owner, etc.) when ready.
Job Location
Written Directions
SITE FEASIBILTTY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
,lruO7l-L
o t)
PROPOSED USE OF PROPERTY
WATER SUPPLY WITHIN ONE MILE OF THE CITY OF (No)__
I hereby certity that the above statemems are true and acorrate, and that I have the following legal intorest in the property:
-owner
of record;
_ @ntract puichasor;
-
potential buyer;
-
realtor or aggnt, I lurther certily that (if not thg owner) I am authorized to ad {or the ownsr ot
record, and that said owner is aware and approves of this action.
TEST HOLES READY call /44d Signature Date
* * * oFFlcE usE oNLY BELOW THIS LINE * * *
SIT &urrrs srATE
gb zDt4a"
/'/o"'Le"v'
EET STATE STAN AR
qAt1,/
otb'or&
*4-/a-
E PLI ANCE
r
Zoning
Acreage or Lot Size TOTAL)
( ) Completed( ) Pending-(r-r--
Partitioning 5 Sn-Q--,
Parcel #
-
AUTHORIZED SIGNA
Permit Processing Section
"#fli4, -t*ffi';o,
/,'a!"*,'r- a-,'
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERI\4iT. ANY PLANS OR EXPENDI'
TURES MADE IN RELIANCE UPON THIS REPOBT ARE AT YOUR OWN RISK. IF SITE IS APPROVED. SEE REVERSE SIDE.
* -&z 4*;/-z 7 4,n,,/hlrb
@aruae DArE
DivKron of Water Pollution Control
LANE COUNTY DEPARTMENT OF ENVIRONNNENTAL MANAGEMENT
c55-32
--r-D^ri/-/
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
a47-3X6/
t
7;-'
fr{
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.
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 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.
)
h_,e_
DEPADTI1ENT OF ENVIRONI4ENTAL I1ANAGEMENT
PSB, I25 EAST 8TH AVENUE
EUGENE, OREGON 9740I
Job Address 4e 'Ji+uP.S-rt,D RD
t1
Appl ication for
Structures now on the Property
l's ii$$$iitl#i.'ffics,r''.ltii: &
Affidavit: I,
If this applicati
Lane County Code
owner of--7-du1y auth
S i gnature/Addres s
Chap ter l0 (zoning) and for no
ontract purcha
- Telephone
l,ihen perm it i s readY not ifY
0v'rner
Con tra c tor
SE-
-islffi,!(i_-, rft rii*#Eli,,djitffiiit /-/iffi$:tiiii
hereby certify that this information is true and accurate
ding it wiII be used for PurPo
other purpose. I have the fo
ses allowed by the State Building Code and
llowing legal interest in the ProPe
I der of an exclusive oPtion to Pu
11
..i$,l,f$i
on is for an a cu tura
record; cr
orized to act for
essee;le o tion.
or Date
l-/ Owner f-l Contractor !Y: /-/ nail
z1
rty:
rchase;
z1
pnane t41-?8d
er
ho
f tnls appl
-Vcontractor's 0SR#/\b8,5 Plumbing by
lV phAppI i ca
UU NOT WRITE BELOW IHIS LI NE
If Commercial
Residential:
&7-88a1 -tSI test holes
#of,.employe es
/] Existing, BP #
17 Proposed, SI #
,E U 6ta btL.
Valuation Fee
$
$
Total Valuation $
$
$
at
at
each $
each $/_t
Received by
Water Supply
\"$
4% State surcharge
Plans check fee
Change of 0ccupancy
Su btota l
TOTAL
X_-nwProposed _
Year InstaI Ied
Existing _
PERMIT PROCESSING
Minimum setbacks
Part. #Parcel #
int
Use Classification
Parcel Size
Da te
t fron t ;t,side rear
.!Comments
To be typed on permit
By
q4r
To be typed on permit
Fire Zone
By Da te
Ph.oneFor plans information call area ins ctor)
x Directions to site
/_/ stF}CP&l set(s )
|,JPC
-
set(s)
Pl ans
t-/ CPIFirt,-/_/ Planning
/-/ Public Works
// Elevation /-/ n/a
/7 Address
/-/ Faci1 ity Permit
/ / Environmental Health
FOR INF0RI\IATI0N about progress of your application call
C74-L7L
Qoto ofi fir-) pla^pd W {ood
Da te
Requ i red
Slip
to PCC
Da te
Compl eted
Date to
PCC
H
permit control center 687-HELP (687-4357)
DOES NOT MEET M]NIMIIM STAI{DARDS.
ADMINISTRA$VE RULES R.EQUIPA 4 MINIMIIM DEPTH OF:
36 inches to an impermeable layer
30 inches to a restrictive layer
60 inches to a permanent water table
24 inches to a temporarily perched water table
OTHER REASONS FOR DENIAL
SI#-)
#Z TES'"- HOLE
ON YOUR PROPERTY THE DEPTH
I.IAS:
inches
inches
inches
inches
#T TEST HOL*-
SITE DOES
PROFILE
Inch
Snul
/4fru*L2
24
36
48
60
PREDICTED WATER
SATURATED ZONE
strictive Layer
]-fl o
1Il o
1n
1n
SLOPE
te
o/
lo
1n
ervious Laye
ttling
erved
cted
Predicted
Observed
Date
A
IN
L2
36
WI
SLOPE
1n
1n
Lo
24
/o
1 n
r
t(o
48
60
INImpervious
Mott ling 1n
PERCHND WATER
SATURATED ZONE
Restrictive Layer
PROF]LE
LnchPredicted
Observed
Date
Predicted
Observed
Date
PLOT PI,AN:
Stream
..----r*\fb
Drainage or
pond
la r.ta..aa.. rla l a
Road
----
Test Hole @
\ % SIoPe
Cut Bank
,, , f r-7-
Fence
tl- X-X
:
tr
e"/-//' tr4P
il# 77 -e(7
SITE EVALUATION WORKSHEET
LocArroN: rwp. l7 RANGE_*f__ sEcrroN-_j36_TAx Lor #Dnd
ZONING:
SIZE OF PROPERTY:
WATER SUPPLY: CoMMuNITy fJ
SUBDIVI S ION/PARTIT ION
cpd
MINIMUM DESIGN REQUIRXMENTS :
Length of disposal trench req'
AMOIJNT US$LE AREA:
PUBLIG
PROPOSED USE:sr-,
INDIVIDUAI
LOT BLOCK PARCEL
E
IF SITE MEETS STANDARDS FILL OUT:
Type of struct.ure and approximate sewage flow:
ltu 1t i-f ami 1y
Conrnercial
gpd
Single Family
Industrial
3a<,8pd
cpd
cPdIns titutional
uired (* *- -d='/750 gaL.
Distribution Method:
Curtain drain required:
Other:
E --r
UEqual
Yes
Seria 1
No E-
SPECIAL S]TE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
NAME:
c74-L26
DATE OF EVALUATION:7
tl
tl
)
)
.1_I.{ LJTI' 3TC}N F'OAD
-]*
(-lT rl 'rYl'?L?-
LmLrrr
rD!- t
rCO
ttr*rr\1 aSAtL f.g.''lic<rg €t>t:€
(>r:<tt.)ta bf ttl L ?"i.,t,D
329'
9
,
I
ti
I
N
2
I
I
II
o,
tJl
l
o
v
$
Wet-u
LrCCtf!"^J
,f
I
tF-N '?,tr "-.*.-,,
ttc3.-ttFr
t><r.' r\
Ftl r:>; r:o
?!€t ) (. :,aa+. L1:. l. (.-.
v\aryD*t,Lu_tftai
:1
. lt'Y!.--\rrr'1- ; i_."*,.: .t
+
rl
4(]
---zo'
;
1-t
i
h;'t
(-
_L_-
b
E x-a lIrE I I ,
+-rH uR a-rCIN p.oaD
LrflLrftrbLL,
(/r?1iitg 6r.a\€LkD.€e\r.e-
.€xv2r*)6 aRLV-LfoLD
5zb
q
q,
I
I
I
/)()Trr.r rY
i?o\_t-1
rlA I
r)lnor
.3:
b
2
a Wett-
L-O(-4(rlC>N
t
11t>
d
ol
Ni
I
I
I
.{.__r,o_ -_ -
gi
\,
+\
I
r-+'^l
,Hl
+=-.-v
\,
h
.'l tOo'
#
\",
F;!', n>. e:p,et..lr I aAo? L6CLtLt_\
ftDtur*9 {ougf Lac fro^){\
llzRlc:AitoFJ rrra!,
-6{t--
C)C>-c> L$ q'
4.,
r)_li
\Q
\
s,tr_ \\"aq\