HomeMy WebLinkAboutPermit Building 1978-09-21S.l. #
TIiS, . L ,3t TL? r3 Job Location
Subdivision:
Lot- Block
APPLICANT'S NAME AND ADDRESS
Mail reportto ()Applicant ()Owner ( ) Prefer to pick up. Call
WATER SUPPLY
I hereby certify that the above statements are true and accurate, and that I
contract purchaser; potential buyer; realtor or agent. I
record, and that said owner is aware and approves of this action.
TEST HOLES READ
Written Directions
SITE FEASIBILITY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL
owNER's NAME aND ADDRESS Phone-
(owner, etc.) when ready,
'-EIUCTUBES NOW ON THE PROPERTY
PROPOSED USE OF PROPERTY ,
WITHI NE MILE OF THE CITY OF (No)-
have lowing 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
SITE: [] MEETS STATE STANDARDS E DOES NOT MEET STATE STANDARDS.LAND USE COMPLIANCE
Acreage or Lot Size (TOTAL)I
Partitioning #
Parcel #
AUTHORIZED SIGNATURE
Permit Processing Section
( ) ComPleted( ) Pending
DATE
THIS IS A PRELII\4INARY BEPORT WHICH DOES NOT ENSURE THE ISSUANCE OF A FUTUBE BUILDING PERI\4IT. ANY PLANS OR EXPENDI'
TURES MADE IN BELIANCE UPON THIS REPOBT ARE AT YOUR OWN BISK. IF SITE IS APPROVED, SEE REVERSE SIDE.
AUTHORIZED SIGNATURE DATE
Division of Water Pollution Control
LANE COUNTY DEPARTMENT OF ENVIRONIVlENTAL MANAGEMENT
c55-32
125 EAST 8TH AVENUE, EUGENE, OREGON 97401 687-4061
* * * OFFICE USE ONLY BELOW THIS LINE * * .
I
l.
(OAR Chapter 340, Division 7, Section 72-02016l: This report shall remain in effect until issuance of a
permit to conitruct, 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 f\4anagement 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.
(
)
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SITE EVALUATION WORKSHEET
LOCATION: TWP./7 RANGE SECTIONOJ /7 TAX LOT #
RA R*)
SIZE OF PROPERTY: /O OOO AOfr * AMOI]NT US$LE AREA:
ZONING:PROPOSED USE:
WATER SUPPLY:COMMIJNITY PUBLIC
SUBDIVISI0N/PARTITI0N 6\eilon /cr"s
IF SITE MEETS STAI{DARDS FILL OUT:
Type of structure and approxirnate sewage flow:
Mrlti-family
Cormnercial
dll
INDIVIDUAL
LOT 1 BLOCK PARCEL
Single Family
Industrial
gpd///J,uo^
8Pd
gPd
tso
8pd
gpd Ins titutional
MINIMUM DESIGN REQUIREMENTS :
Length of disposal trench required /,{o il of 75 l,"o/ fl,lL50 gal.
Distribution Method:
Curtain drain required:
Other:
Equal l<7l Serial
NoYes ^E1*
SPECIAL SITE CONSIDERATIONS OR VARIANGE OPTIONS OR OTHER ALTERNATIVES:
/7 z4
NAME
/trDATE OF EVALUATION:
DQC
gnglnle
c7 4-126
StJon 7{
sr# 7tr - 7o8
#T TEST >r.OLE #z ST HOLE
SITE DOES DOES NOT MEET MINIMITM STA}IDARDS.
ADMINISTRATIVE RULES REQUIPG A MINIMIJ},I DEPTH OF:
36 inches to an impermeable layer
30 inches to a restrictive layer
60 inches Lo a permanent, water table
24 inches to a temporarily perched water Eable
OTHER REASONS FOR DENIAL
ON YOUR PROPERTY THE DEPTH
WAS:
inches
inches
inches
inches
I
Restrictive Layer **t"'i,
lmpervious Layer
-in
72
24
36
48
60
c4,
1n <tq
1
IN
1n
1n
SL0PE O- A %
PERCHED WATER
SATURATED ZONE
Mottling
PROFlLE
InchPredicted
Observed
Date
Predicced
Observed
Date
strictive Layer _inervious Layer in
1n
1n
1.2
36
60SLOPE
J
24 ,,,
IN
lo
1n
PRED]CTED WATER
SATURATED ZONE
ttling
PROFILE
Inch
te
Predicred
Observed
Date
Predicted
Observed
PLOT PLAN:
Stream
--r-f.lf-
Drainage or
pond
la .. lt.aa tt. .4, t I
Road
___-
Test Hole @
\ % SloPe
Cut Bank
777777-
Fence
x-x
S*
48-
x
ll
T
T
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
125 E Y 8TH AVENUE, EUGENE, OREGON O1
PIANNING DMSION Current zoning AVER.AGE PROCESSING
Prrtltlonlng I [eendins f]comp e ted
Parccl No
PArtltlnh{no Reoul red
Other r
}IATET POLLUTION CONTROL
lley Sltr Inepectlon (e)
6DS Con.tructlon [-1 Hey f] nepatr
Nu!6er of Bedroomgt_
Cotmcrclal,/Indu3trlaI - I ol Empl.oyeea
Other
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Address
Mlnlmum Elevation
ffi
tr I of Slter oc
E'o.H,
H
tn
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t,r.x
i.lFo .o
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rrHo
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n coNsrRucrroN pERMrrs AND rNspEcrloN(See abovc for I of bedrooms,/f of ernpl.oyeea)
FEE
n i.toblrc Horoe
fl permanenr
e
Stru"trrF Sq Pt. Valuatlon
s
t
,eoTemporary
Renewa I
?otal v luation S 5
n
orl
. Plunbing fi
__ SewerAater
{l stat6 surch
Plans Check pe€
Frolt lntarl
I Conrn'f
PUBLIC
PUBLIC
E}IvI
es at 9_
att
Each S
nach S
Subtota I
TOTAL BUILDING PERHIT FEE
Betbacks 3
atreet: Front
Exterior slde
lot lines: Side_Rear
ans lheet to appllcant f] CurU cut to appllcant
tr Address t] Minimum Elevltion
D Pacility pernit
HEALTH
Ca.h I
AFFIDAVIT! If rh
'Str:{Rac'd by
oh,ne r
TOTAL S
Iy with all
ls perm
agr icul It 18 for an agricultural buildi I hereby decLare that thlB bulld lng
and
geable of thisable codes relating
bre coLrnty
si,ll be used for tural purposes as allowed by zoning the State Building Code,for no other purpose. I further cert ify that the 6tatemcnta and ot her information submitted onthls applicat ion are true and accura te, and that I have the fol-low lng legal intereat in theproperty: or,tleto purchas;;- d
r of recorduly authori i conCra
zeil--Eo act
ct purchaser;
for a person wE6-has the l6lflowing legal
Iessee; holder of an exclugiveinterest !
opt lon
t or that the ourler of record is knowledonIamf ur therto thls permlt.ro,vADa, il/rlil,Applicant's Signa ,t),A6.eur
THIS IS YOUR RECEIPT, AND DOES NOT GIVE YOU PERI.{ISSION TO BUILD.
FOR INFORI,IATION ABOUT THE PROGRESS OF YOUR APPLICATION, CALL PERI'IIT CONTROL, 587-{357 (687-HELP)G
Change ol s
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