HomeMy WebLinkAboutBuilding Field Test & Inspection Report 1973-02-16Rece iot Number Cocie
.iEQUEST F0R S tTE lliSPECT l0f{
le -o / Za-2o t5o'tes X lic
C. I . fjurnb ai Permit Aree Ui-banizin a r{re-a
C5-; -55 s. l. #-/5
'or 0f f ! ce
lse 0nl y /&Yes ,X No
HIs IS A PR
PI.AN5
lf Subdivision - Name:
INARY REPORT,Y/HICH DOES NOT I}ISURE T}JE ISSUANCE OF A FUTURE BUTLDING PER}',IIT. ANY
XPENDITURES HADE IN RELIAI{CE UPOII THIS REPORT ARE AT YOUR OT./N RISK.
PLEASE PRIIiT v",u
Yes' No
tai ng A<i ress
Owner of Property 0wnerrs Consent Todayrs Date
No. of Sites
No. of .Acres
$
$
$
lS,oo
Z 4
Total 15 o,
Ovner \,/ Sel I er -
-lnterest Buyer Real tor
Other (Specify):
Appl icant I s
in Property:
7 1 ,f **'t*C-
Property Size Legal Access - Road Name Existing Structures on Property
s rope r ty t n ne eo JPioposed l/ater Suppl[
lPubl ic District:
lsprinq }lell
tyes_ t/hat City?x_0ther (Speci fy) :
Property Locat ion (D i rect ions) :
lJhen will test holes be ready? ( ,r?- / { - U )
HARK TEST TIOLES W ITH OUR FLAGS
Location of test hcles on property!
Da(Ie
.{
t
0
Draw diagram of property showing location of any landmarks and relationship of test holes to
these landmarks:
Tn
I
(r,f-ts.
-
I{AKE Cl"iECK PAY!,B|-E T0: HEALTH AND
ilA i i- TC: LANE COUi{TY BU ILD I!{G AND
t.!
!'1:
{'il,l
i;Ali !TAT l0lr
SAli!TATi0l,i ii!liiSlON, \35 t-. 6th A,re.., Eugene, liregon 974A1
.,&d^ $WA^/,$J
Block #
Liownship Rdnge Sectibn Tax Lot No.
{
A,:
I
Ztt:=' : t '3
telePhone f
Prnposed iJse -/ ' ' .. !
of Property;
oblL hh
/
{/(AZ
p tlu L.v
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V*
#
E
,/
ovED
-
r' -"
ENrS: {rzl e,;;4,^tu,
RE/..SC:,t i0a. li0)i-APPR0VAL
STATU'TORY AUTI:CR ITY
oRS q3l . 130 enci I+47.020
3.ri'A lil...3f ur il;;'. :
!nsufiicient !
"IEi'T, icjua i sewage d
hi0T APPROVgD
eff,'
,6 d4"
, drJ,**
fuXrlrl, pb+;HA-,
ncered Site i'locJif icaticn Feasibll lty:
; !b'! e t / ilot Recormended
-
water supPlY.
oAR lrl *030 Par. I
Heavy impervious non-
?516rrtive soil.
oAR 4i-o2o Par- I
Uater tabr I e above m in imurn
ffife standards.
-
ot size fcr
isposal and
tl:or i zecj S ignat
- /(-73
9e!e. . . .
a
,
a
. ':.
a. ..
TWP RG. d=3 :SEC.
COORDINATES E I I I I I I I I
r. L. .roo DATE 2 20
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Nttlllrllttttltlt
CENSUS TRACT l2m rELotir$to S I GNATURE
POSITION
CHECKL I ST
CRITERIA FOR DETERMINING SITE SUITABILITY
FOR DEVELOPMENT UTI LI ZI NG
SUBSURTACE SE\,/AGE DISPOSAL METHODS
GENERAL CONS I DERATI ONS
C.Dr srnrucE To coMMUN r rY SEwERS D r srlnce To PUBL l c wATER
,, t;rri,,0,'L'futy"[,|LES OR FEET,A SOUR C EAMILES OR FEET, SOURCE
3. DrvruopMENr TRENDS rN THE lnra (sHoRT ANo LoNG RANGE popuLATroN oR HousrNG
DU : D,lrul tNo Untt.
u,)f acre. oR LEss-, 2 - ) DU/none- , 6 - lO Du/rcn, /.
oat o_fr
A. Hns ETvTRoNMENTAL suRvEy BEEN coNDUcrEo yEs ATE
,. PnouecrED pLans lr.ro/oR sruotEs FoR puBL rc
r r aooereo).
sEt/ER oR t.lATER rN THE AREA. (rNorcATE
CouurNls:
DENsrrres)
A. Couuerur I
!. Prncrrur oR NUMBER oF FArL rNG sEwAGE orsposAL sysrEMS rN THE GENERAL
'l . So rl CxrnAcrER I sr tcs
Top sorL oEPTH
Suaso r r- DE PTH
Morrl rNG oEPTlr
lt"-hfiE^tA
B
c
D
AND TYPE
{rAND TYPE
WarrR TABLE oEprH
Prncot AT I oN TEsr RESUL TS
>llr77-? - i ,r.)r-.&6
Cottt"tr rur
F.
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I"15 5 - 26
E. F tr-r- FEAS tB tL try
Couue N r
PcnurABtLtry
1
_L
SPECI F I C CoNS I DERATt0ry9
(SuRrace DRA I NAGE cHARAcTER I sr I cs
DRa I Nace 0asrRUct r oHs
Fr-ooo rruc
lv{r u u
Jo rNrr
Drptn
Dna r ruacr Wavs ( Deern )Swat es_:
: Couurrurs
3 WarrR suppLy EvALUATtoN - CxeMtcrr,
./A. Wnren Sounce : puBL tc (r/ Aetnc't
Llrr RrvEn Cour,rrrurs
BacrenroLoGtcAL,
Spn r Nc
Pxvs r clL, QulNrrt r vE
\deul
GEru.Anea
Specrrrc
S rre
B
c USE
Nuuarn or
oF wELL, (# or
PERSONS TO BE
PEOPLE SERVEO
SERVEO Faurlres
C
4 AoorrtoNAL
No
EASEMENTS; DRA I NAGEWAYS, TOPOGRAPHY, SHAPE,
AREA AVAILABLE FOR USE IN CASE OF SEWAGE DISPOSAL SYSTEM FAILURE:
Vts vL ;AMOUNT AND GENERAL LOCATION
5. Acrual usEABLE uND I sruRBEo oR uNALTERED AREA
1'floo, l' -o'
AVAILABLE FOR
s I zE, SLOPE
Torlu stzE oF
SEWAGE O I SPOSAL
PARCEL a ? *<-^"+A. Srope
B. Alaou ru r
Reuanxs:
USEABLE AREA (n
T tl
5
7
PRevrous slrE tNspEcrtoN YES_ No_Z_Dlrrs
DrsrnNcr ro: cnErxS_, srReaus_, Rrv''as .ldni canals_
Lax r s_:Por.ros 0tneR, spEc I Fy:
B Typr or srRUcruRE AND
Mulrr-FAMtLy GPD, lr.rousrn rnl
GPD Norr : So rr-
GPD, Coxueac r au
ABSORBT ION AREA IN SQ. FT.
AppRoxlMATE sEwAGE FLow: SrNcr-e Fauruy s-OO GpD
GPD
I rusr r rur I oNAL
Ane a rurcESSARy FoR sE\./AGE o tsposAL sysrEMS
DATE
REV I ACTION:
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