HomeMy WebLinkAboutPermit Building 1978-09-213,1 11!/rob Lo"u,ion
S.l. #
TRS, TL
Subdivision
Written Directions
Lot j Block-
SITE FEASIBILITY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
APPLICANT'S NAME AND ADDRESS
( ) Prefer to pick up. Call
Phone-
OWNER'S NAME AND ADDRESS
-
-
Phone-
(owner, etc.) when ready
STRUCTURES NOW ON THE PROPERTY
ROPOSED USE OF PROPERTY
WATER SUPPLY WITHIN ONE MILE OF THE CITY OF (No)_
I hereby cortify that ths above statements aro trus and acorrate, and that I have the following logal int€rEt in lh6 property:
-owner
of record;
-
@ntract purchaser;
-
potential buyer;
-
realtor or agent. I {urther certily that {i, not the ownorl I am authorized to act for the owner ol
record, and that said ownor k aware and approver oI this action.
TEST HOLES READY-{ _/--Signature Date
* * *oFFtcE usE oNLY BELOW TH|S L|NE * * *
SITE: E MEETS STATE STANDARDS E DOES NOT MEET STATE STANDARDS.. LAND USE COMPLIANCEv.l AZoning
Acreage or Lot Size (TOTAL)
AUTHOR IZED SIGNATUBE DATE
Division of Water Pollution Control
LANE COUNTY DEPARTMENT OF ENVIRONTVIENTAL t\4ANAGEMENT
c55-32
Partitioning #
Parcel #
AUTHORIZED SIGNATURE
Permit Processing Section
THIS IS A PRELIMINARY REPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTUBE BUILDING PERI\4IT. ANY PLANS OR EXPENDI'
TURES MADE IN BELIANCE UPON THIS REPORT ABE AT YOUR OWN RISK. IF SITE IS APPROVED, SEE REVERSE SIDE.
( ) Completed( ) Pending
DATE
{z
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
Mail reportto ()Applicant ()Owner
lt;
)
OAR Chapter 340, Division 7, Section 72-O2O$l: 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 isued 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.
t)
)
LANE COUNTY DEPARTMENT OF ENVIRONMENT MANAGEMENT
125 ST 8TH AVENUE, EUGENE, OREGOI\97401
t] praNNrNG DrvrsroN current zoning AVERAGE PROCESSING
Paltltlonlng I
Parc.l No.
lnending f]completed
rl
tl
fl
Partltl lnq Reoulred
Othcr r
NATEN POLLUTION CONTROL
UcY Slt. InBpectlon(r)
EDS Conlrrucrton [J uew f] nepalr
Nullber of Bedroomst--
Comnarclal,/Industrlal - I ol Employeee
Oth6r
rEE
oyee a )
I
ion
s
Total v!luation s
. Plurflbing fixtures at
-.
Sewernater Conn. at
I Each S
Dach 3
SubCot! I
at Stat. Surchargc
Plans Check FeG
Change o( Occupancy
TOTAL BUILDING PERHIT PEE
ltlnlmun !tructural
Prom centerlinc o!
cks:
eet: Pront
Exterior sld€
Frolo lnterlor lot ines; Side_Rear
f cono'l plans et to appllcant I CurU cut to appllcant
PUBLIC IANDS Address tr Minlmun Elevttion
PUBLIC WORXS Pacillty Pernit
E}IVI RONlTENTA HEALTTI
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Carh Rcc'd by I TOTAI.
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an agricultural buildlngl I hereby declrre that thiB build ingpurposes as allowed by zoning and/ot the State Building Code, andlor no other purpose. I further certif y that the atatemcntg and other information suhnltted onthla appli.cation are true and accurate,and that I have the following legal intercat in the
APPIDAVI?s Il thl8 pernlt lEul1l be used for agricultural
to thls permlt..
D.r. tr/2// 74 Appricanr,s
ProPerty:
-omer
of recordi contract purcha8eri lessee; holder of an exclulive optlon Ito Purchase,
-duly
authorizeif-Eo act for a person wfiE-hag the !6]flowing tega] lnrerests '
hne corjnty; or that the owner of record is knowledgeable of thisaPPllcatlon,It I am not Lhe owner I further ag Iy with all app cab Ie codec relatlng
Signa
THIS IS YOUR RECEIPT, AND DOES NOT GIVE YOU PERMISSION TO BUILD.
TOI INTORIATION ABOUT THE PROGRESS OF YOUR APPLICATION, CALL PERIIiIT CON?ROL, 687-{357 (687-HELP}
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Mlnlmurn Elevation
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CONSTRUC?ION PERHITS(See abovc for I of
t] :.robtrc non€
tr permanent
e TcmporartT
l--.1 ReneualStructurE-
AND INSPECTION
bedroomsr/l of
Sg. Ft.
Checl I
flcarr I'rlnt - Rr.r rm Alpll(!r lon t('
l.crJ,r'lonlit Lhcn ciq,lct r.d
A!frolrltrf, rl Dxtr
APPLICATI c) I\I Offlce Uee Only
ey elaCLlJ H. 6 ut d
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O1OIER (IF DIFFERLITT)
ADNRESS
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COUTRACTOR
At)l)l{tss
lrllL coHlr,l.Tr.:t) rIRMtT T0
l, PRESENT USE O!'l'ROI'ERTY (reetdentlal; t
THrS PROPERTY (THtS
P]IONE
(:olifkAr:lot' :i ()trf . STAT!: Ltct:NSr-
ER/(;oNlLACtoR ((:lRcLE oHDI I rf,rFrR To prcK ut. cAl.L__
ype of famlng; corerc!el or lndutrl.l; vlcrnti €tc,)
arv E 4AP
) ARE:bt ltdt ctat -6G,u,Olrt l
y''. Et:p 7 apc /laPa -nb
1. DESCtlliE:iTlU(.1t,ltt:s NOl, ON ntE pl{01'tiR.l.t. lt()1.I ANI.S]l(trc.fURES TO Bl. DL]t()l,H;[]:l)
T-o- -?-E:-- _
4. furrrnE |LANS:-__.L4n!j/U/e)_ %_-
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PLOT TL^JI Shetch (a) al
proposed s*e(g) easr:rentr
o r I nrlur t rla I
lrttll!tt
I roads (b) b<-tndar.tea of property (c)
ge dlsposal areac (e) exlstlng/proposed(h) dratnogeaysr straros, crecke, auy
, ahou fllq5jsndtng :lgns. parklng erea,
extstlng/proposed bul
uells (f) extstln8/p
othcr p"rtlnent fertu
INDICATE DIHENSIOI{S
ldlnti (d) exlarlng/
roposed drlverayg
rea. tf coonrclel
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lEFoRt: YoUR AlPl.lCAl loN CrL\ 8E PRoCESSED YoU f,tLrsT t-utL{IsH: ...---___8!xt I pLoT fLA}ts LEGAL DEscRIpTIoN
( D I HENS ION T:D)
BY
LANE COUNTY DEPARTMEN'T OF ENVIRONMENTAL MAJ\IAGEMENT
125 EAST --:H AVENUE, EUGENE, OREGON 974.
ldne county
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SITE EVALUATION WORKSHEET
LOCATION: TI.JP./F RANGE SECTIONc)/?TAJ( LOT #
ZONING:RA PROPOSED USE:R^)
SIZE O[ PROPERTY:
WATER SUPPLY:COMMUNITY PUBLIC
SUBDIVISION/PARTITION 6Ieilon Ic.*s
IF SITE I'TEETS STAI.IDARDS FILL OUT:
Type of struct,ure and approximate sevrage f low:
ItuIEi-family
Conrnercial
AI'IOUN'T USABLE AREA:6ll
INDIVIDUAL
Single Family
Indu s t.ria I
Ins titutional
Lor 3 BLocK____TPARCEL
tso
/0ooOo,Pfl$
l:]
ePd/a
8Pd
sPd
roc
8Pd
cpd
MINIMUM DESIGN REQUIREMENTS:
Length of disposal trench required
Distrlbution Method: Equal
Curtain drain required: Yes
Ot,he r :
/60 il or 75 ln.o/ fl /150 gal.
B riSe al fllroffi
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
DATE OF EVALUATION:rg/i/ 76
NA}IE:
DDC
b^gl,1c
c7 4-126
StJon 7{
#T TEST HOLE
PERC}IED WATER PROFILE
Pre dic ce d
Obse rved
Da te
n lnch
1n
t2
SATURATED ZONE ,,
Predicted
Obse rved
Da te
IN
1n
24 <o
e
1
36
[{r'st.ricLive Luyer ?9!L i"
Impervio
I.lotrling
us Layer no^? in
rtoae lo E0 in 48
SLOPE O- L %60
>2
IIZ TEsT HoLE
PREDICTED WATER
Predic ted
Observed
Dat.e
in
IN
SATURATED ZONE
Predicte d
Obse rved
Date
IN
n
rRestricLivc Layer in
ilmpervious Layer in
lMottling l_n
SLOPE o/
PROFILE
Inch
124
24-
36-
48-
60-
X DOES NOT MEET MINIMTJM STAI\iDARDS.
ADI'IINISTNATIVE RULES REQUIRE A MINIMUI'I DEPTH OF:
36 inches to an impermeable layer
30 inches to a rest,rictive layer
60 inches to a perrnanent. wat.er t.able
24 inches E,o a t,emporarily perched water table
OTHER REASONS FOR DENIAL
S Lil 7&- ?t /)
ON YOUR PROPERTY THE DEPTH
!{AS:
inches
inches
inches
inches
I
SlTE DOES
PLOT PI.AI.I:
Stream
--*\.ff_Drainage or
pond
lr,'lr.tt a.. rart a
Road
'['e s t HoIe @
r. % Slope
Cu t lJank
777777-
Fence
x-x
S* ?L+ M^p Lol J
tr