HomeMy WebLinkAboutPermit Demolition 1978-10-05s.t. #
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Subdivision:
APPLICANT'S NAME AND ADDRESS
Job Location
Written Directions
Lot- Block
SITE FEASIBILITY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
1LE Phone
OWNER'S NAME AND ADDRESS Phone
Mail reportto ()Applicant ()Owner
RUCTURES NOW ON THE PROPERTY
( ) Prefer to pick up. Call (owner, etc.) when ready.
PROPOSED USE OF PROPEBTY ,
WATER SUPPLY
I hereby certify that the above statements are true and accurate,
contract purchaser; potential buyer; realtor
record, and that said owner is aware and approves of this action.
WITHI NE MILE OF THE CITY OF (NO)_
have following legal interest in the property:
-owner
of record;
certify that (if not the owner) I am authorized to act for the owner of
and that I
or agent. I
TEST HOLES READ Signature Date
* * * oFFlcE usE oNLY BELOW THIS LINE * * *
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SITE: t] MEETS STATE STANDARDS E DOES NOT IVIEET STATE STANDARDS LAND USE COMPLIANCE
Zoning
Acreage or Lot Size (TOTAL)
/*Partitioning #( )'Completed( ) Pending
Parcel #-
THIS IS A PBELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PLANS OB EXPENDI
TURES IIIADE IN RELTANCE UPON THIS REPORT ARE AT YOUB OWN RISK, IF SITE IS APPROVED, SEE REVERSE SIDE.
?5.u;*.! P P /bd*?il
AUTH6R IZED SIGNATURE DATE
Division of Water Pollution Control
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
c55-32
AUTHORIZED SIGNATURE
Permit Processing Section
DATE
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
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OAR Chapter 340, Division 7, Section 72-020(61: 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 repoft 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 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.
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Flcare Print - Rcr rm Af'pl1(atlon r(' AllDolrrnn.0r nrri
l...lt lonlrl Ltren C'rq'l.tr.d
APPLICATIO N Offlce Uee On ;
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4, FUTI,RE ILANS:-
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PLOT TLAN Sketch (a) aLL roa.ls
proposed seage dlspo
(g) oascu'nts (h) dr
or lnduetrr,al, ahoe f
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ypc of fn tmt,rB i
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l, DESCrltrE srRU(:TtlRr:S NOIJ ON TttE pt0t'tiRly. N()lE AN\ Sllilrc.ruREs ro 8t. DLH()LIriltfr)tlE d 7-o- --?-z---
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(b) bc'rndarlce of property
sal arets (c) exlst in8,/pro
rlnsBsays, streaosr creeks
rrestsndlng 81Bns, parklng
' (q) exlst tng/proposed butldtnga (d) axlatlog/
'posed vells (f) exlstlng/proposed drlEU.ya
. aDy othcr pertlnent fettures. If cocrclalarers. INDICATE DIMENSIONS.
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slTE INST,ECTION Tt.ST ltoLEs RFjDy (DATE)
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lf fORl YoUll Al'Pl.lCn1 lfiN ()\{ EU Pl{OCt:SSt;t) )'(}t, HtrS'f tlrRt,t tstt tllr I I PLOT It-A!'lS L!:CAI, DttSCRtpTlON
( D r l,rL\S 10N t:D)
ldne courty-:fupw,6r\-
A,,L /\NE COUNTY DEPARTMEN'T OF ENVIRONMENTAL MANAGEMENT
125 EAST 8TH AVENUE, EUGENE, OREGON 97401
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RANGE
SITE EVALUATION WORKSHEET
SECTION /7OJ TAX LOT #LOCATION:
ZON ING:
rwP. r
RA PROPOSED USE:R^)
SIZE OF PROPERTY:
WATER SUPPLY:COMMUNITY PUBLIC
SUBDIvISI0N/PARTITI0N 6/enrlon 1"."s
IF SITE MEETS STA}.IDARDS FILL OUT:
Type of structure and approximate sewage flow:
ltuIti-family
Connnercial
A}IOT'NT US$LE AREA:6llnAoO6?ft't
INDIVIDUAL I]
ot /y' sl-ocK----PARCEL-L
Single Famlly
Indu s tria I
gpd//C,",tso
8Pd
gPd Ins ti tu t, ional
8pd
8Pd
MINIUU}I DESIGN REQUIREMENTS :
Length of disposal trench required
^fo
tu or 75 ln.o/ f/./L5o gaL.
Dlstribution Method:
Curtain drain required:
Other:
Equal [l SeriaI
NoYes ^E
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
NA}IE:DATE OF EVALUATION:rrtil 7L
Ddc
Aapi/7
c7 4-126
a
3tJon 7{
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#2 TEST HOLE#T TEST HOLE
PROFILE PROFILE
lnch Inch
aL
,u,,
1at
6 a u?
SATURATED ZONE
Rc s tric t ive LayeE-g14_in r
lmpe rviou s Lay ec -fr,lnJ in,
ftotcling_--zfr,.,p )5-&D in.
S LOPE o/
in,
ln.
PERC}{ED WATER
]-Il r
in.
Pre dic te d
Obse rved
Dat,e
Predicted
Obse rved
Date
36-
lo
t/48-
12-
24-
60-
PREDICTED WATER
SATURATED ZONE
Restrictive Layer _lnImpervious Layer in
IN
ln
SLOPE o/
IN
1n
1n
Mot t I ing
Predic ted
Obse rved
Date
Predicted
0bse rved
Dat,e
12-
24-
36-
48-
60-
SITE DOES DOES NOT MEET MINIMUM STANDARDS.
ADMINISTRAIIVE RULES REOUIRE A MINIMI.J}I DEPTH OF:
36 inches to an impermeable layer
30 inches to a rest.rictive layer
60 inches to a perrnanent water table
24 inches t.o a t,emporarily perched wat,er table
OTHER REASONS FOR DENIAL
ON YOUR PROPERTY THE DEPTH
I{AS:
inches
inches
inches
inches
PLOT PI,AN:
Streanr
..-^hra..},i-
Drainage or
pond
l...\rtaa...laIa
Road
Test Hole @
\ % SloPe
Cut Bank
,1, f Ir-
l'e nce
tl- X-X
Su. pL+ M^p Lof //
92/
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LANE COUNTY- 'OARTMENT OF ENVIRONMENTAL I' ^NAGEMENT
125 EAS'I 8TH AVENUE, EUGENE, OREGON 97*- r
NG DMSION Current Zoni
Partltlonlng l_ lPending ted
Parccl No._
Partltlonlnq Reoulred
Other r
TEI POLLUTION CONTROL I o( Sl
Dlcr Stt. Inspectlon (e)
6DS Con.tructlon [-l Nev f] nepatr
Nunb€r of Bedroorner_
Comurclal,/Industrial - I o! Enployea!_
Othcr
AVERAGE PROCESSING
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tl CONSTRUC'TION PERTIIITS AND INSPECTTON(See abovc for I of bedrooms,/l ot ernployeoa)
tl :,{oblt. Hoto. $
tl p€rmanent
tl TamPorary
t] Renewatstructurc sg. Ft. valuation
rEE
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s
TotaI v!luntion S
. Plunbing fixtures at g
_ SeYern.ter Conn. at t
Each S
rach 5
5
ot,
Subtotr I
{l statc surchargG
Planr Check Fe.
Change o( Occupancy
TOTAL BUILDING PERHIT TEE
ltlnlrnun .tructurll aetbacka :
FroE centerlinc of atreett Front
Exterior Sldo--
Proto lnt.rlor lot linccl Side_ Re!r_
fl Cono'l planr sheet to appltcant f] CurU cut' ro appllcant
PUBLIC TANDS t] Address t] Minlmun Elevltion
PUBLIC l.roRxs i] Facility it
ENVI
Ch.slCarh
AFFIDAVIT: If thlcuil} be used for agr
'd bv
for an agricultural buildlngr I hereby declare thrt thiE bulldpurposes as allowed by zoning and/or the State Building Code,certify that the atatemcnts and other information submitted onate, and that I have the followlng legal intercst in the
lng
andfor no otherthta applicat PUlPOse.ion are
permlt i'1cuI tura,. I furtrue andproperty: _orner of record con tract purchaseri lessee; holder of an excluslve opt lonto purchaae; _duly authori zeil-To a ct for ! person wE-o--hag the fdflowlng legal lntereats
or that the opner of record is knowledgeable of thisam not L (: owner further ag y with all le codes relating
bne county
to thl8 pernlt.nv ?r/ zr/ ?8 Applicant I a Signature 4zur
THIS IS YOUR RECEIPT, AND DOES NOT GIVE YOU PERITTISSION TO BUILD.
I'OR INPORXATION AAOUT AHE PROGRESS OF YOUR APPLICATION, CALL PERIIIT CONTROL, 687-{357 (687.HELP}
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Mlnlmum Elevation
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