HomeMy WebLinkAboutMiscellaneous Miscellaneous 1972-1-20
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$.ECEI'..:T No. 5?97cJS- ~.~ ~.. /7RANGE52. SEC.3~-
!J?/.f. TAX LOT, NO. ..fhOd).f.ODE/9-0j'
REQUEST FOR SITE I NSPECr'io'N DA TE / _ /.::L -7d1-,.
BY,&",.a"'''S' /!/~/W/ Mm '"' ',,"m ~~/ ~/. 70<-. ,P-Pd
Vc..J<v,f ~
OWNER OF PROPE~ ~ SIZE OF PROP.. '?~ ~~~~~d._
CONSENT OF OWNER? Is PROPERTY CONTIGUOUS TO ANY CITY LIMIT? ~~
EXISTING STRUCTURES ON PROPERTY ~~ ~ _
//b/~ ~
SOURCE OF WATER SUPPLY: PUBLIC SPRING WELL: DRILLEDX""IJRIVtN DUG
DESCRIPTION OF SITE (0'""""" "'"'"''' '~'" '" ", "., ~':;.;; ~~
me~~~~~~~~'g
o . . ~~.g;f",," '""""''' "" ",,,,,,,,.),
tI
/
l:p
CJ
URBANIZING AREA.
FEE:
No. OF
No. OF
SITES-L
ACRES
TOTAL-
...::_ ~ 0
)v( ~ J
$
$ J;-CJ 0
SPECIAL PERMIT AREA.
RESULTS OF INVESTIGATION:
f)"1.~ +0
5l-\V'--C" c,/ Ih /5
bas'/c- rc'!uIY-eme",{s
Q ~,' 5l WI ~ te> I'- '~DI. l.e Ii'"' -+ ct l / e...) /(/io I ~!;,...,-
51 Jw does no f In ee.+ j"), 12- )n/norn IA no-.....
-rov"" S:,DS.
T~IS IS A PRELI~INARY REPORT WHICH DOES NOT INSURE THE ISSUANCE OF A FUTURE BUILDING
PER:':IT. ANY PLANS OR EXPENDITURES MADE IN RELIANCE UPON THIS REPORT ARE AT YOUR OWN RISK!
BEFORE CONSTRUCTION IS STARTED BRING THIS FORM TO THE BUILDING AND SANITATION DIVISION AND
MAKE APPLICATION FOR A BUILDING PERMIT. IF THE PROPERTY IS A PORTION ONLY OF A TAX LOT, A
METES AND BOUNDS DESCRIPTION OF THE PARCEL MUST BE FURNISHED. EXACT SPECIFICATIONS FOR T
SEWAGE DISPOSAL SYSTEM WILL APPEAR ON THE BUILDING PERMIT. Two SFTS OF THE BUILDING PLA
AND PLOT PLAN WILL BE REQUIRED.
LANE COUNTY BUILDING AND SANITATION
~~ ../
BUILDING INSPECTOR
0,
DIVISI01Qn~
~ 5"","",
J- ') ()-'7 Q..
- DATE
THIS REPORT IS NOT COMPLETE WITHOUT THE SIGNATURES OF THE BUILDING INSPECTOR AND SANITARIAN.
c'~0t1-07
i
NP. /7
RG. 2
SEC.
3.
T.L#ut13~OZ-
DATE ~-,/.$ _ 7
<l-
COORD I NATES E
N
CENSUS TRACT I II :i?1
1/1~".sT
SIGNATURE J l(LQ
POS I TI ON N. 10 I ~/1 b I
CHECKLI ST
CRITERIA FOR DETERMINING SITE SUITABILITY
FOR DEVELOPMENT UTILIZING
SUBSURFACE SEWAGE DISPOSAL METHODS
GENERAL CONSIDERATIONS
1. DISTANCE TO COMMUNITY SEWERS
AO; I{ MILES OR
2. DISTANCE TO PUBLIC WATER
fEET, SOURCE
A.,MMILES OR
rEET, SOURCE
A. COMMENT 1
TRENDS IN THE AREA (SHORT AND LONG
DU = DwELLING UNIT.
OO/A~ OR LESS ~5 DU/AeRE
,
RANGE POPULATION OR HOUSING
3. DEVELOPMENT
DENSITIES)
6 - 10 OO/ACRE
4.
A.
HAS ENVIRONMENTAL SURVEY BEEN CONDUCTED YES NO
THE GENERAL
hTE
AREA
'f,
PERCENT OR NUMBER Of fAILING SEWAGE DISPOSAL SYSTEMS IN
5. PROJECTED PLANS AND/OR STUDIES fOR PUBLIC SEWER OR WATER IN THE AREA. (INDICATE
If ADOPTED).
COMMENTS:
SPECIFIC CONSIDERATIONS
1. SOIL CHARACTERISTICS
A.
Top SOIL DEPTH AND TYPE
-ttt; - :1('};/"1,., n"",-
/-I ec;.V~ c I ~j
:2. D "(
to"
/,'o.l -I
vl~
B.
SUBSOIL DEPTH AND TYPE
C.
MOTTL I NG DEPTH
WATER TABLE DEPTHLJ.,.Ie-.
Pt
J-J-" ) -'- ()
"
I,t;
D.
COMMENT
/
E. FILL fEASIBILITY
PfHrr
COMMENT
F. PERMEABIL ITY
G. PERCOLATION TEST RESULTS
2.
e
SURFACE DRAINAGE CHARACTERISTICS SWALES
eAINAGE WAYS (DEPTH)
,
.'
'"
DRAINAGE
OBSTRUCTIONS
~
COMMENTS
FLOODING
3.
WATER SUPPLY EVALUATION - CHEMICAL, BACTERIOLOGICAL,
A.
WATER SOURCE: PUBLIC
_ AGENC Y
SPRING
PHYS I C AL7QUAN AT I V E
WELL
LAKE
RIVER
COMMENTS
GEN.AREA
SPECIFIC
SITE
B. WELL DEPTH
C. JOINT USE OF WELL, (# OF PEOPLE SERVED)
NUMBER OF PERSONS TO BE SERVED
FAMILIES
4. ADDITIONAL AREA AVAILABLE FOR USE IN CASE OF SEWAGE DISPOSAL SYSTEM FAILURE:
No
/ YES
AMOUNT AND GENERAL LOCATION
.
5. ACTUAL USEABLE UNDISTURBED OR UNALTERED AREA AVAILABLE FOR SEWAGE DISPOSAL -
A.
EASEMENTS, ORA I NAGEWAYS, TOPOGRAPHY, SHAPE, SIZE, SLOPE
SLOPE 1'/100' ~~O 0
AMOUNT USEABLE AREA ~
C.
TOTAL SIZE OF PARCEL
3ac'('Q.,
B.
REMARK S :
6. PREVIOUS SITE INSPECTION YES No ./ DATES
7. DISTANCE TO: CREEKS , STREAMS , RIVERS CANALS
LAK ES , PONDS , OTHER, SPECIFY:
8. TYPE OF STRUCTURE AND APPROXIMATE SEWAGE FLOW: SINGLE FAMILY 1]00 GPO
MUL T 1- F AM I L Y
GPO,
INDUSTRIAL
GPO, COMMERCIAL
GPO
INSTITUTIONAL
.
GPO N()TE: So i,t, ABSORBT ION ARE A IN SQ. FT.
AREA NECESSARY FOR SEWAGE DISPOSAL SYSTEMS
-------------------------------------------------------------------------------------
DATE
REV I EWED BY :
ACTION:
..
.,
e...-L
.
~,
T../7 R . ~.s- TAX LOT ;;;'12-
CENSUS ~ /~_/~-:.-
APPLI CAW:
NAME r Q';'Affi,.L/ ~
AODRESS -1.'I...6'~",/.
PHONE / ;1~ .:J lS plJ
DATE /- /3 _ 72-
BUILDING SITE EVALUATION
() Building Permit Appl ication No.
() Site Inspection -# ff'!?CiS
() Pre-Permit Investigation
LANE COUNTY PLANNING DEPARTMENT
NOT
aDDl icab I e
() ()
( )
( )
( )
( ) ( )
COMMENTS: ~~ ~~--";A
NO
YES ~
(~ t/~.A.d#A
() f f
( )
( )
~
DATE
I.
Zoning Ordinance Compl iance
(Zone )
Subdivision Ordinance Compl iance
j- /7- 72..
3.
Requ i red Access
( )
( )
( )
2.
4.
Building Site (Area, Width,
Fronta~e, Setback)
Other (see comments)
5.
...-/ ' ;.-U..U_;_P~"
rJ ,-
--
BUILDING INSPECTION SECTION NOT NO YES NAME DATE
aDDl icable
6. PI ans Submitted ('>4- ( ) ( )
7. Soil Stabil ity (footings) ~ ( ) ( )
8. Flood Plain ( ) ( ) / /7 A
9. Other (see Comments) ( ) ( ) ~ /....-/9'-12:-
COMMENTS: /
TO APPLI CANT:
Your Building Permit I Site Inspection:
() Can be approved.
() Cannot be approved at this time as indicated on item NO. above.
Questions and further infonnation on items I through 5 contact the Lane-
COUNTY PLANNING DEPARTMENT. Questions and further information on items 6
through 13 contact the Lane Countv Buildinq and Sanitation Division.
( ) ,Will be held in this office until you can resolve the problems indicated.
() Is being returned.
() Your building permit application fee is being returned under separate cover.
LANE COUNTY PLANNING DEPARTMENT
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342- 1311 EXT. 231
LANE COUNTY BUILDING & SANITATION DIVISION
135 Sixth Avenue East, Eugene, Oregon 97401
PHONE: 342-1311 EXT.411
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