HomeMy WebLinkAboutPermit Building 1978-10-10s.t. #
TR5, TL Job Location
Written Directions
Lot- Block
SITE FEASIBILITY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
APPLICANT'S NAME AND ADDRESS
Subdivision
Phone---
Phone-----OWNER'S NAME AND ADDRESS EE
Mail reportto ()Applicant ()Owner
-TRUCTURES NOW ON THE PROPERTY
( ) Prefer to pick up. Call (owner, etc.) when ready.
PROPOSED I,JSE OF PROPERTY
I hereby certify that the above statements are true and accurate, and that I
contract purchaser; potential buyer; realtor or
record, and that said owner is aware and approves of this n
TEST HOLES READ
WI IN ONE MILE OF THE CITY OF (No)----
the following legal interest in the property:
-owner
of record;
certify that (if not the owner) I am authorized to act for the owner of
Signature Date _-.---
. i * OFFICE USE ONLY BELOW THIS LINE * * *
LAND USE COMPLIANCE
Zoning
Acreage or Lot Size
AUTHORIZED SIGNATURE
Permit Processing Section
Aal/(TOTAL)
Partitioning #-( ) Completed( )Pending
Parcel #
-
THIS IS A PRELIMINABY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTUBE BUILDING PERIi]IT. ANY PLANS OR EXPENDI.
TURES I\4ADE IN RELIANCE UPON THIS REPORT ABE AT YOUR OWN BISK. IF SITE IS APPROVED, SEE REVERSE SIDE.
t 7f
A R IZED SIGNATURE DATE
Division of Water Pollution Control
LANE COUNTY DEPARTMENT OF ENVIRONTVIENTAL MANAGEMENT
c55-32
DATE
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
,
SITE: E [/IEETS STATE STANDARDS E DOES NOT MEET STATE STANDARDS.
)x
n )/
)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 [Vlanagement 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.
I )
I
LANE COUNTV DEPARTMENT OF ENVIRONMENTA' '4ANAGEMENT
125 Er'-, 8TH AVENUE, EUGENE, OREGON t"+01
PLANNING DMSION Current Zoning
Plrtltlonlng l_ f]Pending
Prrccl No._
Partltlonlnq Reouired
OthGr r
nAIEn POLLUTION CONTROL I ol St
UcY Slt. Inspoctlon(.,
t
6DS Conrtructton [J r.rcn f] nepalr
}{unber of Bedlooms!_
Conncrclal,/Industrlal. - I o! Employee!
Other
CONSTRUCIION PERMITS AND INSPECTION rEE(Seo abovc lor I of bedroonrs,/l of
tl :ltobll. Hoto€
tl permanent
E renporary
tlStructu16
AVERAGE PROCESSING
ted
r
tl
fl
r,ulh
)il
E|
6l!''-
vrct(,.
H.
Ho
E
'otHo
)i
$
s
Renesa I
Total vlluat
. Plunblng fixtures
SewerAater Conn.
Sg. Ft.luatlon
s
I
tt
s
t
6)tt
Subtot!l
at Stat. Surchargo
Plana Check Fes
Change o( occupancy ''
}{lntraun rlructuraS
ProD centerlinc df
Srolt lntarlor t lines: Side Rear
PUBLIC
PUBLIC
r! rheet to appllcant fl Curb cut to appllcrnt
tr Address tr Minlmum Elevation
tr Pacillty pernrit
E}IvI
Each I
llach S
TOTAL BUILDING PERHIT FES
ot,
f[ cono'l pI
\]'\,0
APFIDAVIT: -If thls Permit is for an agrlcultural buildlng, I hereby declare thrt thl! bulldlngw111 be used for agrlcultural purposes as allosed by zoning and,/or Lhe state Building Code, an6for no other purpose, I furth€r certify that the statemcnia and other infornation submltted onthla application are true and accurate, and that I have the followlng legal inter.rt ln the
ProPerty3 _onner_of record; _contract purchaaeri _lessee; _holder of an exclutlve optlonto purcharer
-duly
authorizeil--to act for a person n66-hag the Eflowing legal lntereet:
CGrh_ Ch.cL I
ll[rllcatr,on, if I am not thc owner. I further agree
TOTAL S
i or that the oener of record is knowledgeabl,e of this hE ccx.rnty
t comp with alI cable codee relat latto thls permlt. ,
D.r. g/ e//za Applicantrs Signature 26,etr
THIS IS YOUR RECEIPT, AND DOES NOT GIVE YOU PERIqISSION TO BUILD.
tOI INFOnXATION AAOUT lHE PROGRESS oF YOUR APPLICATION, CALL PERIT|IT CONTROL, 682-t357 (6A7-HELP,
-)
Address
Mlnimum Elevation
!atbacka:
atreet: Front
-
Exterior Slda-_-
I
s
s
I
Is
I
d*-V
s
s \€;
SI#d- 74
SITE EVALUATION WORKSHEET
/F CJ /7 TAX LOT #
ZON INC:RA PROPOSED USE:
SlZ[ OT PROPIIRTY:/D 0 00 {"?f| * Al,or;NT usArLE AREA: a tl
LOCATION: TWP.RANGE SECTION
WATER SUPPLY: COI-{MTJNITY PUBLIG
SUBDIVISION/PARTiTION 6Ieilon Ic.*s
IF SITE MEETS STANDARDS FILL OUT:
Type of structure and approximate sewage flow:
MrIti-family
Conrnerc ia I gPd
rNDrvrDUAr [f
l-/ BL}CK__PARCEL----
P*)
LOT
Single Fanily
Industrial
spd/J,"o
gPd
cpd
tso
gpd
Ins titutional
MINIMUM DESIGN REQUIRIMENTS:
Length of disposal Erench required A{o ft Or 75 l,*o/ fl./150 gal.
Distribution Method:
Curtaln drain required:
0the r :
EquaI EJ
Yes
Serial
No ^8,
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
DATE OF EVALUATION:rs/i/ 7L
NA}.{E:
Ddc
Congbl e
c74-t26
StJon 7{
tr
it TEST }IOLE II 2 TEST HOLE
PERCi{ED WATER PROT'ILE PROFILE
Pre dic te d
Obso rverd
Datc
IN lncir lnch
itr
L2 T2
SATURATED ZONE
Predicce d
0bse rved
Da Le
1n
1n
24 24
36
8(
36
Re s t.rictive l,ay er gLn
lrr{rssyipus Layer 4inl'lottling --r**\ tb in
t0
48 48
SLOPE o/
lo 60 60
X
PREDICTED WATER
Predic ced
0bsc rvcd
Date
SATURATED ZONE
Predicted
se rved
1n
lfl o
1n
1n
SITE DOES DOES NOT I"IEET MlN IMT]M STA}IDAR,DS.
ADMINISTRATIVE RULES REQUIRE A MINIMIJT'I DEPTH oF!
36 inches to an impermeable layer
30 inches t,o a rest.rictive layer
60 inches to a permanent wat,er table
24 inches t,o a temporarily perched water Eable
OTHER REASONS FOR DEN
a t,e
strictive Layer
-.in
Impervious Layer in
ttling
SLOPE
1n
o/
ON YOUR PROPERTY THE DEPTH
I.trAS:
inches
inches
inches
inches
I'LO'I' I'LAN:
Stream
.---E-.*-
Drainage or
pond
a...ta..ar. tlrl t
Road
Test Hore @
r 7, Slopc
Cut Bank
777777-
i"cnce
xcx
S* ?L+ M^p lol 7
T AT
I
t;.?Ltc^x16/Et</ Dz,uf cfel -f76Zyl'
ADpRESS_-__€./<t L
OIJ}IER (IT DIFFERL\T)
ADnr E SS-- -
ll,case Prlnt - l{(.t rm Applltatlon to
1...1: 1on1ir then Cool,lcl t.d
ApFolrth.ill Ditr
APPLICATI (] t\I87 4,/.s2,L/J /J. 6utcl
Offlce Usc Only
PHON E 3/,t - 78do'
-ctct 846E,)E-_zrp 7
PIIOTE
_CONfRA( tol'li l)RI STATE LtCI:NSE
ER/coNrR-Aclor (clRcLE oril[ I pRtFER To prct< un.
ype of femlng; courctai or lndutrlrl; v.c.nt etc. )
ztP
E
!
E
$t\
$St
\
N\
\
Id
oz
zo
t
:
Eo
J{
oFI
,{
F
coNTtAcToR . __ ._ _
ADD'I[SS_-. .
HAII. COHll,l-Tlr) PIRHIT
l. PRESEXT USE Ol- PROTERTY (reEtdontlsl; t
/4 dEz r e /!dPA
2' DESCRIIiE $',rRU(ITURIS NOI, ON TrlE PRoPtiRIY. N()TE ANI Sl.lttrc.ruREs To B!. DE]tol,rsil[:r)O ttot AN E Py*tfzr- a- ___7-_o__ __3_4_ D_loat-/ llz>
THIS P (tills APP!.)
^RE:
0rL)6eztt ,4aP
4. l'UTtrRE I'[.ANS:- _ -&3-!4 !-UUle)_
P \
I
5. PLOT ILAN 5kr.tr:
Propo(s) e
or ln
h (a) all ro.rds (b) borndarlee of prrrperry (c)
scd soage dlsposal areas (c) exlsrlng/proposedaeeEnta (h) dratnageeysr strcroi. creeks. auJurtrl!I, lhw freestandtng sltnS parking areer
cxtstlng/proposed bulldtnts (d) exlrtlng/uells (f) exlstlng/proposed drlveuaysoth.r partrncnt f!rtures. If corrrclel
INDICATE DIHENSTONS.
ti
F)h
o
rLli
riii
t.t'-
I
I
I
I
N
)
\
N
\
\
*
I
E
FUI
oz
>lo
-t
oErofd
z
'i)\r
N
s
r.^G*.6
3
9
]U
n
l2
ll
l4'
,,r, ^, ,) o,:. ncxr-e,t;r -1! !* q_o2 {p[-t,SITT: INSI,ECTION T[5T I()LES REAr}Y (DATN)
\(
$r,ll rrv
il
NI.\
Hl rllr)D Ol Sl'L',\{:t' l,lSP()SAL 7/c
I'Nt)l'OSll) lt,\Il:l{ 5t'l'l'l Y
E!,E(:TRICJTY TII|i.;ISIIED 8Y _EyZA _: _---
ul Ll --sl'RIN(; Sll(|AH LAKiI NA 7'E L
tiATuRiL (:AS ltY _ -
i
i
r'
rIRE I)ISTRICT ..
SCIIOOL DISl RICT
Pi"ult8Ili(: BY
'ttttttt'rttttrtttlt'l'ttt't'rrr f{) N(rT tnITt BEl,oli Tkrs LINE rrrr.t.rrt.rirttrrrttralt.rrrrr
lEtORt. YOUR AI'PI.lO11 ION C]\N BE PROCISSEI) YOU MI'ST l'trRlllSH: _*__, _-._-.8\xt I pLOT PLANS LE6AL DESCRIPTION
(D I XENS IONED)
bre carty
,4-61<t-r l),\Tt,7 6S
-
LANE COUNTY DEPARTMEN OF ENVIRCNMENTAL MANAGEMENT
125 EI 8TH AVENUE, EUGENE, OREGON I )'I
PHONE
I
I
I
i
I
I-l
itlt:- - I - . - .-i
t't r ,... l_l -l l
i
I
I
I
I
I
I
I
I
I
I
I
;
I
t
I
I
l,:
I!,1--,-.. . ..F j-
I
_l_Il"
I
I
I
l
l.
I,
I
l:
l
..1'-1 __
I
I;'
i
I:- : ..: -_
I
I
:1.
/_'t