HomeMy WebLinkAboutPermit Building 1980-09-24BI
. FS, TL
Subdivision
Lot- Block
APPLICANT'S NAME AND ADDRESS
OWNER'S
REPORT F RF EANDA
Locati
S D L S.I.
Written Directions
RESS Phone=-_-
Mail report ( ) Owner ( ) Prefer to pick up. Call (owner, etc.) when realy.
STRUCTURES NOW THE PROPERTY /2*:-zZ PROPOSED USE OF PROPERTY
WATER SUPPLY WITHIN ONE MILE OF THE CITY OF (No)_
I hereby certify that above statements are true and accurate, and that I have the foltowing legal interest in the property: -lSlvner of record;
-
contact purcha.or;
-
potsntial buyor;
-
rcaltor or agent. I further certify ttEt (if not the owner) I am authorized to act for the ownor ol
NAME AND,ADD
to @{p1i*n1
record, and that said
TEST HOLES READ
aware approves of this action
Si gnature
* * * * * * * * * * * * * * * * * * * * * * * * * x r+Qf,flQE USEONLYBELOWTHIS f * x * * * * * * * * * * * * * * * * ri {+ r( * {r * * r} tt
SITE MEETS STATE STANDARDS
Septic Tank/ Drain Field
Sand Filter
Holding Tank
Other
NO
tr
E
E
E
YES
E'
tr
tr
tr
N SE COMPLIANCE
Acreageor Lot svM (TorAL)
partition i ng - 228-rD- [rffi6,"0
I Zoning
fro
Parcel #
Lare-to'ulIr
l.\ L aL,'\-,
ux.t"t s 1\,o
"'ArJ'
RB/
tXSl s aj.J G*tu Z{
GPE IT. A Y PLANS OR EXPENDI-
ct nD L, LO
THIS IS A PR MINARY EPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUI
TURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK. IF SITE IS APPROV E BE.VE
1-Zs-
AUT SIGNATURE DATE AUTHORIZED IGNATUR
Division of Water Pollution Control 687-4061 Permit Processing Section
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 125 EAST 8TH AVENUE, EUGENE, OREGON 97401
c55-32
\a' ,\-
L!
E.
Date
-
\
)
MEMO
TO: APPLICANT
FR0M: WATER POLLUTI0N C0NTR0L DIVISI0N
SUBJECT: CONDITIONS OF SITE APPROVAL
OAR Chapter 340, D'ivision 7, Sect'ion 72-015(6): This report shall remain 'in effect un-
till issuance of a permit to construct, unless in the meantime conditions on this or ad-
jacent properties have been altered in any manner which would prohibit issuance of a per-
mit, in which case this evaluation report shall be considered null and vo'id. Technical
rule changes will not invalidate any evaluation report issued pursuant to this section.
Before construction js started bring your approved Site Feasibility Report to the Depart-
ment of Environmental Management and apply for a building perm'it. Exact specifications
for the sewage disposal systern will appear on the permit.
If the property is only a portion of a tax lot, a part'it'ioning or subdivision must be
approved before the permit will be issued. Before a cosntructjon permit may be jssued
Land Use Compl iance must be approved.
0n1y persons having a vafid license issued by the Department of Environmental Quality
under QRS 454.695 to install subsurface sewage disposal systems or an owner or contract
purchaser or hjs regular employees may install subsurface sewage disposal systems. A
cert'ificate of satisfactory completion wjll not be jssued if persons other than the above
perform the j nstal I ation.
)
Job Address
Appl ication for
Structures now on the property
cation is for an agr cu tura tdi
Code Chapter 10 (zoning) and for no o
,{I!I!EOlKl:
/_-/ rl,iiillJis:itffi$fiti /--i iffiSj:ffi
hereby certify that this information is true and accurate.
rposes allowed by the State Building Code and
DEPARTNENT OF ENVIRONMENTAL I'IANAGEMENT
PSB, I25 EAST BTH AVENUE
EUGENE, OREGON 9740I
Y
/-/
ng it wiII be used for Pu
ther purpose. I have the
tr/
i*u+:l$fi$ff,it{utiriiffi
R
Affidavi t: I
If this appli
Jfl:ii;following legal interest in the prope
holder of an exclusive option to pu
rty:
rchase;r of record;contract purchaser;I essee;
authorized to act for the owner, who is [nowl ed-geabl e ofTEI s appl i cati on
Si gnature/Addre
Hhen permit is ready notifY
'el ephone or
v
/_ / Appl i cant 2( 0wner l-l Contractor
z1
te
Owner
Con trac tor
z1
(zl o)
Phone
NO
7// - oq? e
Contractor's 05R#Plumbing by
If Commercial:
Residential
# of employees _:*r.rt;l;Uurtttilii:iiiilii:rlliiii .:
-
li$$$n:ii /-/ Existing, BP #
! Proposed, SI #
,:tB€i,
$s4p
SI test holes ready
i0iE$r,r:!iH**Uti::
.l.riitt:iil,; r iffi,tu:i
:lf:,::qf;::i,$,lt+*:r: ',, s$i$-:l Val uat i on Fee
$
Total Valuation $
$
$
$
at
at
each $_
each $t_t
Recei ved
Water Supply
Proposed
Year Instal led
4% State surcharge
Plans check fee
Change of Occupancy
Su btotal
TOTAL
$
$
$_
$rruooExisting _
PERI'4IT PROCESSING Zone
Minimum setbacksr t,
Cornments
To be on permit
Part. #Parcel #Parcel Si
Da te
fronl-;t, side i nt.
By
Group.Fi re Zone Use ClassificationCP&I Type_
To be typed on permi t
By Da te
For plans informati (area i tor )
Di 1
ns
/-/ srF)to CP& I
I"IPC
Da te
Requ i
d sli Da te
Compl eted
Date to
PCC
(s)
-(s)to PCC --ffi
/1 Planniny-
/ / Publ){Works
-,/UEleuation //n/a
l/ Address
l-/ Facility Permit
/-/ Environmental Heal th
C74-L7 L
a
:
4.
5.
INSPECTION RE ORD
Approved D'isapproved t-O
C)
-.{o
=
Site Inspection
Foundation Inspection
Framing inspection
Lath or Sheetrock Inspection
Final Inspection
,. ' , 6. .Sl ab Fl oor, Pl umbi ng Groundwork
7. Gas Piping Groundwork
B. Rough P'l umbi ng
9. Rough Gas Piping
.l0. Fjnal Plumbing
ll. Final Gas Piping
Remarks:
I
2
3
!mv
=-{
+
12. Cert'ificate of 0ccupancy:
ready to issue; _ not ready;date;i nspector.
a------1
,a
ccuniy r
I
MEN,IORANDTJM [ane
TO
FRON,1
SUBJECT 57,6O-o5Lt+ -JL-ot 24,-4 t t30 DATE ? -1*8C
Type on Permit:
NOTE:Minimum floor elevation wiIl be required for any
construction other than septic systems. Floodplain
I'lanagement 687 -4357
lane county
HOrm stlP 6llL\_I7APPLTCATT0N # fu.trZ4_
LOCATION
NAME
ADDRESS
ZIP COD E
The Lane County Water Pol lution Control Division cannot proceed with
processing your appl ication because:
I . Z Incomplete app'lication ('items def icient) .
Address and/or direct'ions to application site.
l'JProposed number of bedrooms in dwe11ing.
flnpprovable plot plan (see attachment).
l-J ruotlfication of date test holes will be ready.
Verification of existing system required (memorandum
explaining this procedure attached).
eep )ged
fi el
2
3
4
Two test holes (2'X4'X5' d
or repair of existing sewa
area of the proposed drain
required for expansion
isposal system in the
ds.7eother:t<\htt ltt a ,?u bd tltct
kdlu'h3S?Df-%
SEfi-A'TURT DATE I
OFFICE HOURS PHONE
If the necessary correct"ions are not made with'in
application will be denied.
days, the
BUILDING & SANI.INI ION / ENVIRONMENTAL MAN YENT DEPARTMENT
125 East Bth Avenue / public Service guilding / Eugene, 0regun 97401 / {503)687-4061
fl
lane countrl
ffiotxp sE.f,P 6m!'{rFAPPLICATION #
LOCATION
NAME
ADDRESS
The Lane County Water Pol lution Control Division cannot proceed with
processing your appl ication because:
1.Incomplete appl ication ( i tems deficient) "
l_l naOress and/or directions to app'licat'ion site.
IProRosed number of bedrooms'in dwelling.
l-l Approvable plot plan (see attachment).
[-l t'totification of date test holes will be ready.
Verification of exjsting system required (memorandum
explaining this procedure attached).
Two test holes (2'X4'X5' deep) required for expansion
or repair of existing sewage d'isposa'l system in the
area of the proposed drainfields.
2
3
4 Other:
SIGNErURE-_
OFFICE HOURS PHONE
If the necessary corrections are not made within
appl ication wi I I be denied.
days, the
BUILDING & SANITNTION / ENVIRONMENTAL MAN YENT DEPARTMENT
l 25 East gth Avenue / publ i c Servi ce Bu'i 1d'ing / f ugene, Oregun 97401 / (503) 687-4061
DATE
lone county
ffi(Dr,m s&np
APPLICATION #
LOCATION
{/NAME
ADDRESS1
The Lane County Water Pollution Control Division cannot proceed with
processing your appl ication because:
t.Incomp'lete appl ication (items defic'ient).
Address and/or directions to applicatjon s'ite"
Proposed number of bedrooms in dwe11ing.
Approvabl e p1 ot pl an ( see attachment) .
[J ltotification of date test holes wil] be ready.
Verification of existing system required (memorandum
explaining this procedure attached).
Two test holes (2'X4'X5' deep) required for expansion
or repair of existing sewage disposa'l system in the
area of the proposed drainfields.
2
3
4 0ther:n,{n
't'
E
If the necessary corrections are not made within days, the
appl ication wi I I be denied "
BUILDING & SANITXTION / ENVIRONMENTAL MAN/ ',IENT DEPARTMENT
125 East 8th Avenue / public service Building / Eugene, 0regurt 97401 / (503)687-4061
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ZIP CODE
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S IGNATURE DATE
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- 17 03244t
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APPLICATION #
bne county
4,/arc,
Z pd
LOCATION
NAME
ADDRESS
The Lane Countyl,laterPollutionContro.lD.ivisioncannotproceedwith
processinq Your appl ication because:
('items def icient) '
I a IncomPlete aPPl ication
l_l naaress and/or di rect'ions to aPPl i cat'ion s
[-[ proposed number of bedrooms in dwelling'
l-Z Approvable plot plan (@
2
t-l Notification of date test holes w'ill be rea
Ve rification o f existing sYs tem required (memorandum
exp taining thi s procedure at tached) .
Other:
Two test holes (2'X4'X5' d
or- rePai r of ex'i sti ng .sewa;;.;-bi the ProPosed dra'in
eep) required for exPansion
g.'litptiiat sYstem in the
fields.
3
4
I
days, the
h^lt A/u @/ P'b"
If the necessary correct'ions are not made w'ithin
appliciilon witt be denied"na{
MAN. -MENT DEPARTMENIgT)urr-oou,
O..gon 97401 IION I
\,
,
srP0 i] 1990 >
Water P:!'.:i;ona
6
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ENVIRONMENTAL
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SI#
SITE EVALUATION WORKSHEET
LOCATI0N: TWP. I7 RANGE 153 sr,cr;oN c{.O TAX LOT #/27
ZONING:RA.PROPOSED USE:
SIZE OF PROPERTY:AMOI]NT US$LE AREA:
WATE J PUBLIG
LOT BLOCK PARCEL
1F STANDARDS FILL OUT:
Type of structure and approximate sewage flow:
/zq d tTD
cpd
Slngle Family
Industrial
cpd
8pd
8pd
Itulti-f amily
Corunercial 8pd
MINIMUM DESIGN REQUIREMENTS :
Length of disposal trench required
Ins titutional
/l5O gaI.
Distribution Method:
Curtain drain required:
Other:
\
J-or^,k -J,n,Loa.*-
1r U(LU1L
Equal |XJ
Yes
SUBDIVIS ION/PART IT I ON
?lt
SPECIAL SITE CONSIDERATIONS ES:
4 CI
3P+ /s'* Gtx 3 1 zs'
t\.
llt
ll
il
NAME:
c74-t26
DATE OF EVALUATION:Q-tt - Fa
[f TNDTvTDUAL l]
Serial f.]
NolFJ
t,
LI
SATURATED ZONE
Predicted
Observed
Date
rodr (,i (z) u'
sr#
ON YOUR PROPERTY THE DEPTH
ITIAS:
inches
inches
inches
inches
fu-sd/
+1 TEST HoLE
.-I WATER
,dicted
served
1n
l_n
Date
1n
1n
|.\o \o
Restrictive Layer _itImpervious Layer in
Mottling 1n
SLopE tr-3€L y
SITE DOES DOES NOT MEET MINIMTJM STANDARDS.
ADMINISTRATIVE RULES REQUIRE A MIN]MUM 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
#Z TEST HoLE
f ooe,
24'r? 24
ln
ch
("
QI
1-l t96/P
l_n,#
utt-s ,\-o f*rdgL(kv
48
L
,j
60
1n
2
tr
36
g-
48
60
Sr"*l
!o-
SL0PE 0'3 %
PREDICTED I^IATER
SATURATED ZONE
ttling
PRO}-ILE
Inch
36
redicted
strictive Layer _i,
,l_n.
l-II o
Predicted
0bserved
Dat.e
g-6
served
te
ervious Layer in
PLOT PI,AN:
Stream
.-..fr\-
Drainage or
pond
aa r.tt.rtta. aa,t,
Road
Test Hole @
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Cut, Bank
.tt ttf
Fence
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H(}fl,m SLIP
APPLICATION #
LOCATION Hev isE N tl6l?\aV- Kl
VJ NAME
ADDRESS2,,13{/ ('rL
--7TP-TODE
The Lane County Water Pollution Control Division cannot proceed with
processing your appl ication because:
t.Incomplete application (items def icient).
Address and/or directions to application site.
f][ ProRosed number of bedrooms in dwe11ing.
Approvabl e p'lot pl an (see attachment)l G,'; ,. * -i
2
3
[-] notlfication of date test holes will be ready.
Verification of ex'isting system required (memorandum
explaining this procedure attached).
Two test holes (2'X4'X5' deep) required for expans'ion
or repair of existing sewage disposal system in the
area of the proposed drainfields.
L
4 Other:lsfl,{
tP
ir^-J{-
l'rLi
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J ,^(Jt
rJauw^ l\{L.n',rrt
S IGNATURE m
NE
)
H
If the necessary corrections are not made within
application will be denied.
/sl) days, the
BUILDING & SANII,-iON / ENVIRONMENTAL MANP .,IENT DEPARTMENT
tZ5 East Bth Avenue / Public Service Building / Eugene, Oreg,,- 97401 / (503)687-4061
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