HomeMy WebLinkAboutPermit Septic Tank 1989-02-24do urc-SP,,€(sL,/SEWAGE DISPOSAL SIT E EVALUATION
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Written Directions
Brock---l) l;
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lnt if WATER SUPPLY Ztpto
C,ntAPPLICANT'S NAME AND
OWNER'S NAMEAND
sTRUCTURES NOW ON THE PROPERTY
I hereby certify that the above statoments are true and
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PROPOSED USE OF PROPERTY 4 Ao
'+realtor or agent. I turther certify that (it not the owner) I for the owner of record , and that said owner is aware and
accurate, and that I have the following legal interest in the property: _owner of record; _contract purchaser; .L/botentialbuyer;
approves of this action.
TEST HOLES Signatu
oFFIcEUSEoNLYBELowTHISLINEtt*t*tatt*Itttt*t*titattt
SITE MEETS STATE STANDARDS
Standard SYstem
Sand Filter
1 Foot CaPPing Fill
NO
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YES
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NO
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YES
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Low Pressure Distribution
Holding Tank
Other
LAND USE COMPLIANCE
Zoning Acreage or Lot Size (TOTAL)
Partitionino # ooraat
) Comoleted
) Pending
FLOODPLAI N INFORMATI ON
! Approximate
Study Area
n Detaited
Study Area
! Floodway
All or.part o, this site may be in a flood hazardarea tor which 1 00 year flood levels have notDeen established. Extra precautions mav beappropriate to assure that the bulhing siie wittbe reasonably safe from flooding.
All or.part of this site may be in a flood hazardarea lor which 100 year flood levels have beenestabtished. A building etevation aOove ihe iooyear flood level may be required.
All or.part of this site may be in a flood hazardarea,ln which a floodway has been designated.rruildrng may be prohibited subject todemonstration that the cumulative effect ofpro-poserJ-development will not increase lhe100 year flood level at any point.
THIS IS A PRELIMINARY REPORT WHICH 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.
LANE COUNTY ENVIRONMENTAL
c55-32
TH, 125 EAST 8TH AVENUE, EUGENE, oREGoN 97401 (687_4051)
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MEMO
TO: APPLICANT
FROM: LANE COUNTY ENVIRONMENTAL HEALTH
SUBJECT CONDITIONS OF SITE APPROVAL
lane ccunty
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 adjicent properties have not been altered in any manner which would prohibit issuance of a permit in accordance with
O.n.S.+s+.o05ihrough qiq.lssandAdministrativeRulesof theEnvironmentalQualityCommission.Anysuchsubdivision,
partitioning or alteration may void this report'
vvARNING: 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 of 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
earlier cancellation, pursuant to Commiision 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 Quality 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 certlficate of satisfactory completion will not be issued if persons other than the above perform the installation.
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A build ing permit is requi:.
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SITE EVALUATICII FIELD HONKSUEST
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Lane
APPLICATION #
LOCATION
NAME
ADDRESS
ZIP CODE
The Lane County Building and Sanitation D'ivjsion cannot proceed with processing
your application because:
l. n Incomplete application (items defjcient).
Address and/or directions to app'lication site.
Proposed number of bedrooms in dwelling.
Approvable plot plan (see attachment).
Not'i f i cati on of date tes t hol es wi I I be ready.
tr Verification of exist'ing system required (see attachment).
n Two test holes (2'x4'x5'deep) required for expansion or repairH of existing sewage disposal system in the area of the proposed
drai nfi el ds .
u Other:
HOLID SIIP Countg
2
3
4
S IGNATURE DATE
to from to
OFFICE HOURS PHONE
If no response has been received in regards to this matter by
the application will be denied.
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
Courthouse-Public Service 81dg. / 125 E. Bth Ave. / Eugene, 0R 97401 / 687-4051
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