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Home My WebLink AboutApplication Applicant 2/27/2024City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477L' SPRINGFIELD LAND USE COMPATIBILIITY STATEMENT (LUCS), DEPARTMENT OF MOTOR VEHICLES (DMV) and ZONING VERIFICATION LETTER Application form D - , Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement: ❑✓ City: ❑ Dept of Motor Vehicles -Renewal: ❑ Zoning Verification Letter: ❑ UGB: ✓❑ Project Information Applicant Name: Amy Chinitz, Water Resources Administrator Phone: 541-726-2396 com an : Springfield Utility Board E-mail: amyc@subutil.com Address: 202 South 18th Street, Springfield, OR 97477 Property Owner: Springfield Utility Board Phone: 541-726-2396 Company: Springfield Utility Board E-mail: amyc@subutil.com Address: 202 South 18th Street, Springfield, OR 97477 ASSESSOR'S MAP NO: 18030100 TAX LOT NO 5 : 3000, 3201, 2900, 1302 Property Address: 1295 South 26th Street Description of proposal/ request: Springfield Utility Board plans to construct a new municipal drinking water well at its Willamette Wellfield. The proposed Well #16 will be located approximately 50 feet from the well it is replacing (Well #15). As part of the water rights transfer application, the Oregon Water Resources Department requires this LUCS. Record Information (Staff to complete) . _ q' Date Received: 23Record No Application Fee: � Technical Fee: TOTAL FEESAssigned Planner: Revised 2023 04 04 s1m OREGON Oregon Water Resources Department Land Use 725 Summer Street NE, Suite A Salem, Oregon 97301-1266 Information FormR- � (503)986-0900 WATER RL•SOL'RCES 1) E PA RT M E N T www.oregon.gov/OWRD NOTE TO APPLICANTS In order for your application to be processed by the Oregon Water Resources Department (OWRD), this Land Use Information Form must be completed by a local government planning official in the jurisdictions) where your water right will be diverted, conveyed, used, and developed. The planning official may choose to complete the form while you wait or return the "Receipt Acknowledging Request for Land Use Information" to you. Applications received by OWRD without the Land Use Information Form, or the signed receipt, will be returned to you. IMPORTANT: Please note that while OWRD can accept a signed receipt as part of intake for an application for a new permit to use or store water, a completed Land Use Information Form is required for OWRD's acceptance of all other applications. Please be aware that your application cannot be approved without land use approval. This form is NOT required if: 1) Water is to be diverted, conveyed, and used on federal lands only; OR 2) The application is for a water right transfer, allocation of conserved water, exchange, permit amendment, or ground water registration modification, and all of the following apply: a. The existing and proposed water use is located entirely within lands zoned for exclusive farm -use or within an irrigation district; b. The application involves a change in place of use only; c. The change does not involve the placement or modification of structures, including but not limited to water diversion, impoundment, distribution facilities, water wells and well houses; and d. The application involves irrigation water uses only. NOTE TO LOCAL GOVERNMENTS The person presenting the attached Land Use Information Form is applying for a new water right or modifying an existing water right. The Oregon Water Resources Department (OWRD) requires applicants to obtain land use information to ensure the water right does not result in land uses that are incompatible with your comprehensive plan. Please complete the form and return it to the applicant for inclusion in their application. NOTE: For new water right applications only, if you are unable to complete this form while the applicant waits, you may complete the "Receipt Acknowledging Request for Land Use Information" and return it to the applicant. You will receive notice via OWRD's weekly Public Notice once the applicant formally submits their request to OWRD. The notice will give more information about OWRD's water right process and provide additional comment opportunities. If you previously only completed the receipt for an application for a new permit to use or store water, you will have 30 days from the Public Notice date to complete the Land Use Information Form and return it to OWRD. Your attention to this request for information is greatly appreciated. If you have questions concerning this form, please contact OWRD's Customer Service Group at 503-986-0900 or WRD—DL—customerservice@water.oregon.gov. OWRD Land Use Information Form — Page 1 of 4 Last Revised: 10/2023 This page intentionally left blank. OWRD Land Use Information Form — Page 2 of 4 Last Revised: 10/2023 Land Use Information Form NAME Attn: Amy Chinitz OREGON Oregon Water Resources Department 725 Summer Street NE, Suite A Salem, Oregon 97301-1266 (503)986-0900 WATER RESOURCES 11 EPARTM ENT www.oregon.gov/OWRD PHONE 541-744-3745 MAILING ADDRESS 202 S. 18th St. CITY STATE I ZIP EMAIL OR 97477 amyc@subutil.corr �J A. Land and Location Please include the following information for all tax lots where water will be diverted (taken from its source), conveyed (transported), and/or used or developed. Applicants for municipal use, or irrigation uses within irrigation districts, may substitute existing and proposed service -area boundaries for the tax -lot information requested below. Township Range Section y, y, Tax Plan Designation (e.g., Water to be: Proposed NW SE Lot f1 Rural Residential/RR-5) Land Use: ISS 3 W 1 3000 Public land & ® Diverted ® conveyed ❑ used Municipal 18S 3 W 1 NW SE 3201 ❑ Diverted ® Conveyed ❑ Used 18S 3 W 1 NW SE 2900 Open Space ❑ Diverted ® Conveyed ❑ Used 18S 3 W 1 NE SE 2700 ❑ Diverted ® Conveyed ❑ Used (Within boundary of Springfield and adjacent territory) ❑Diverted ®Conveyed ®Used List all counties and cities where water is proposed to be diverted, conveyed, and/or used or developed: _ City of Springfield, Lane County NOTE: A separate Land Use Information Form must be completed and submitted for each county and city, as applicable. B. Description of Proposed Use Type of application to be filed with the Oregon Water Resources Department: ❑ Permit to Use or Store Water ® Water Right Transfer ❑ Permit Amendment or Ground Water Registration Modification ❑ Limited Water Use License ❑ Exchange of Water ❑ Allocation of Conserved Water Source of water: ❑ Reservoir/Pond ® Ground Water ❑ Surface Water (name) Estimated quantity of water needed: ® cubic feet per second ❑ gallons per minute ❑ acre-feet Intended use of water: ❑ Irrigation ❑ Commercial ❑ Industrial ❑ Domestic for household(s) ® Municipal ❑ Quasi -Municipal ❑ Instream ❑ Other t3rIeTIV desCri0e: The Applicant is proposing to add an additional point of appropriation, Well 16, to Certificate 27979. The location of the well is listed on this form and shown on the attached map. The only land use impacts will be a new well and conveyance in tax lot 3000, and conveyance lines in tax lots 3201, 2900, and 2700. The applicant will pump water from the new well into existing infrastructure and continue to deliver water to municipal customers within its service area. OWRD Land Use Information Form — Page 3 of 4 Last Revised: 10/2023 For Local Government Use Only The following section must be completed by a planning official from each county and city listed unless the project will be located entirely within the city limits. In that case, only the city planning agency must complete this form. This deals only with the local land use plan. Do not include approval for activities such as building or grading permits. Please check the appropriate box below and provide the requested information ❑ Land uses to be served by the proposed water use(s), including proposed construction, are allowed outright or are not regulated by your comprehensive plan. Cite applicable ordinance section(s): ❑ Land uses to be served by the proposed water use(s), including proposed construction, involve discretionary land -use approvals as listed in the table below. (Please attach documentation of applicable land -use approvals which have already been obtained. Record of Action/land-use decision and accompanying findings are sufficient.) If approvals have been obtained but all appeal periods have not ended, check "Being Pursued." Type of Land -Use Approval Needed (e.g., plan amendments, rezones, Cite Most Significant, Applicable Plan Policies Land -Use Approval: conditional -use permits, etc.) & Ordinance Section References ❑ Obtained ❑ Being Pursued ❑ Denied ❑ Not Being Pursued ❑ Obtained ❑ Being Pursued ❑ Denied ❑ Not Being Pursued ❑ Obtained ❑ Being Pursued ❑ Denied ❑ Not Being Pursued ❑ Obtained ❑ Being Pursued ❑ Denied ❑ Not Being Pursued Local governments are invited to express special land use concerns or make recommendations to the Oregon Water Resources Department regarding this proposed use of water in the box below or on a separate sheet. Name: Signature: Governmental Entity: Title: Date: Phone: Receipt Acknowledging Request for Land Use Information Note to Local Government Representative: Please complete this form and return it to the applicant. For new water right applications only, if you are unable to complete this form while the applicant waits, you may complete this receipt and return it to the applicant. If you sign the receipt, you will have 30 days from the date of OWRD's Public Notice of the application to submit the completed Land Use Information Form to Oregon Water Resources Department. Please note while OWRD can accept a signed receipt as part of intake for an application for a new permit to use or store water, a completed Land Use Information Form is required for all other applications. Applicant Name: _ Staff Name: Title: Staff Signature:. Date: Governmental Entity: Phone: OWRD Land Use Information Form — Page 4 of 4 Last Revised: 10/2023 fell sail I � N ME 10 U � � ma� r10 a M r�Q d mew oL V m C c It- - ° ,,.ee -E- g e C o o o N rL l°n HE j 1_€ -__ G P.t it = __ i z� \ m La a a e m Q r . tr M iBLL-8\ pi y y0 Mom. z c O �C4 Aso L. ic F W z¢ ��yn8ip�_y°E I �'3�S0 C7 u fell sail nO 2 W �- 9. 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