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HomeMy WebLinkAboutPermit Septic Tank 1999-10-06 I . ~,""'".(d ~s SE~IC INSTALLATlON PIrnIT SP997380 ~~. , . ......."""'" , Parcel Number: 17-02-36-30-0] 300 Applicant: LA V ASSEVE MAR V 1705 MINDA DR EUGENE OR 97401 Site Inspection Number: 95-279 Work Description: INSTALL SAND FILTER SYSTEM System Type: INSTALL, SAND Applied Date: 09/02/] 999 Approved Date: 10/06/] 999 Issued Date: ] 0/06/1999 Expiration Date: ] 0/06/2000 INSTALLATION REOUlREMENTS: (a, an, _~Du"ty - Site: MAIN ST TO 79TH RIGHT TO S. A ~7"6 ,.,~ <<"~H- llfAJY Owner: PECK BRIAN 7740 S. A ST SPRINGF]ELD OR 97448 ~ .t.c e.-y Jst,~..'9 a,..,t'9/.&. oJ Projected Dai]y Flow: 450 gallons Septic Tank Size: 1000 gallons Drainfie]d Size:]50 feet Maximum Depth of Drainfield: 24 in. Special Conditions: INSTALL DRAINFlELD ON CONTOUR CALL FOR INSPECT]ONS " .. SANITATION SETBACK REOUIREMENTS: From drainfield to property lines and structures: ] 0 feet From drainfield to well: 100 feet From septic tank to property lines and structures: 5 feet From septic tank to well: 50 feet ~ Au~ed DEQ Agent -~-- 34i?~(!~~/r /ifX. 77f/ ~if~z..6~ CI11f /~rT7,e 91' /~ J'.Ar6 M.J 7fP4af ;=;t6 - " Jd/6/ry Date! / This oermit will expire after one vear unless the svstem has been insoected. To obtain an inspection, make a drawing of the system 'as installed on the form provided. Submit the completed form to this office and the inspection will be scheduled. Final insnection for sewal!e systems cannot be reouested bv teleohone.. LANE COUNTY ON-SITE-SEW AGE OFFICE 125 E 8TH A venue, Eugene OR 9740 I. Ph: (541) 682-3754. Fax: (541) 682-3947 . . , . ~l D.Q MA\0 \. ! , ea O.J ~1' Brl'{'" -}. r'c>><, J/t, r?( If 77'10 s;.o. A ~i / ~{~r'V1.5 (1(' 1,( 1Ar ! .oJ' )1: U () Z~ &, 313 D () ,I ~s\'os~ '],~ ;-e.~ ~~~ J\'\l9J~...1 / \11."'" ~V.i' ~ef\\\\\a' u- , ~.-\l .:::-t . ,~~ !OS '0 ~.. p..\. ~ ~\ fJii\\)\\\'\""'p..\. ;t\\ p..'Jt.llll' 1 e~ ,~,~ o\l. ~,411' -,.7 t\\~;X- /" qe; - j/ 4TTENTION" Oregon law r~u'lTes 'Iou to tollow 'ules elimlted by the O(sgon Utility Notification I;.nte' The.. rules ere sel 'orth in OAR 952.00~-O010 Ihrough OAR 952.001-0090 You"'y obI... cop.e.ot 'ha rulo, hy ..mn9lhe cent". \lIole: Ihelelephone ',umll.. ter Ihe Otegnn Ulilily NotificallOl1 Genla' b '50JI2J2,19871. DATE RECEIVED fo/97 JOB NO. 7''1/;::'03 - 'ZONE OCCUPANCY G"~I~IP UN'T(S) OCCUPANCY LO,J\r STOR1ES J TYPE CONSTRug.!Q~ LEGAL,'~E5C~!"N '7f}~~;..n g4~eD M'DRE~5 .d..;Y..7.lt!:. ~,"'F" ~&J_EC';.J:' . - TH\! CONTE".~~:': H~.)S. -:',.,,: HNJE BEEN REVIEWED. W1T~ ALTERATIQi.J":~ 'N0IL;~':::e :;.', COLORED PENCIL. CHANGE~ OR ALTERk"fl\":'I'-:- "''Ii,~~': 'TO "fHE. APPROVED ORAWING~ OR PROJECT AFT!:-" '!;.'~': t'i.\-rE pEL..OW SHALL BE APPROVED BY THE 9UIL.OH..jG. OFF'ICIA:". C,TY OF s~' OR'G~bl.. !'PPROVED BV RIl.L; . DATF..~ ! ' ,.". I!!f I!'/ j.,we ~. ;)Av/l>>rMcJ ./1111' ~ V J lr---= ~ ~ 1'<:> :p < '.... ";j ~ -. C' ~ ~ . , ~ 't- ."...- -",' lilt:: I fiJJ ATTENTION:Oregon law requires you to ~ 1 ~ ~~ IS follow rules adopted by the Oregon Utility J ~ ~t'YI\ Notification Center. Those rules are set forth _ ~.~ in OAR 952.001-0010 through OAR 952-001- ~ ,6, - . ~ t'\\ _ 0090. '(ou m!!y obtain copies of the rules by '11> calling the center. (Note: the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). ~,,' I 10' l . 10 , , '0' __ DI.4,..b...d, 0 I , I- {'?IX z{' I 1/"" ~13// 1/ NOTICE: THIS PERMIT SHALL EXPIRE IF THE WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. ~f1i)P rlj1v z,- -€) Stt>rM VJ ItTt;tl .... 'i,I,;,,- fl"./1- I ~-If- 11"" , I I() ---.. --. --- - k, t, ~ /'-hl'Jll Ok '1.;1(' t> ,LJvlI!< ~&- G-iI<"'I'~'.:, II ~<f', lut"t\ / it.M.) .i I__J I I 21. ' :;,,- ~ t!. F1t--r: .- ./ II;:, "z. ' .;;0 _10'-. l w.1I , _ --- r'V~t2 P"It' 30 I (I -I-1-D <; 0 "If :; f' (I '1,\-1' 1<>1.01 '. 20'x181 Intermittent Sand Filter* with Gravity Discharge * Configured for loading rates up to 1.25 GPDIFT. 2 Follow appropriate intermittent sand filter design criteria. ~ ~ ~-..... CII Orenco Systems<El Incorporated . 1-1/4" PVC Manifold ; ~JO Mil PVC Uner >> Orifice Shield ---..:.-c----=<" --~_-_-----_-. -~~ '\ JO" --:-----0- /' '\ ~------~ ----- :>0 "". ~-~ --~---~~~+ =1 1\..... ;J" . I' ,- -Discharge Une c- - --'----- - - ----- ~-.- <>{) 2)' I ~ ./ r-- - Flushing Valve Box .0-.0--_- =:. ----------: --")00 :>0 ~ 18' 814 AIRWAY AvENUE SUTHERLIN, OREGON 97479-9012 24" '" ( TELEPHONE: (541) 459-4449 FACSIMILE: (541) 459-2884 4" Class 125 Slatted PVC Pipe-.. (1/4" wide slots 2-1/2" . deep at 4" an center) End Cap J/4" PIIC Laterol (w/ 1/8" dia. orifices) From OS! Effluent Pumping System c . '-... ~----- Air Coil System TOP VIEW - 20'XIB' GRAVITY DISCHARGE SAND FILTER, SCALE: I' . 5'.0' Note: See additional details on EOW-ISF-S-J Potent # 5,360,556 (i:) 1998, Orenco Systems, Inc, EDW-ISF-2018L-l Rev. 1.0 (2/98) Typical Intermittent Sand Filter with Gravity Discharge In cold weather applications, slope entire transport line and manifold system to drain back into tank. If draining back is not possible, reler to non-drainback orifice detail on drawing EDW-ISF-S-3. 4" Class 125 Slatted PVC Underdrain Pipe (may be laid flat) PVC Lateral PVC Boot With Ori/ice Shields Filter Fabric Air Coil System '~~:P: t~;:a;OCk.~ LL..., \ ul .I .... ~~::'n:o:alve 6"-8" Loamy Sand .._._-_..~,'" Sand (back/ill ~'. ... .~ .~.~~-.~. ~":.~';''::::''''...;. -..::.. ~- ~ .... ~.,-"~"' - '~.'--'" ~ ~.'. ',"" . '. -..;,~. ~ -" ..". - "', a._ -. ........ _-T'.'..... -. . '-~, ~ ~ . ...- '-1 ...... ..~ ...:. - I d) . ""-' -"C=:~"~:a.Gr~vel'~~~ ......... ,'.., ., ........... -... ...." "';i;r::;:1:~~;j;r~::;~:b:l' .."-, ... ....~ ~;;~o. J/4" Rock 1/2" - J/4" Rock " ~Air Coil JO Mil PVC Liner 2" Sand Leveling Layer (below JO Mil PVC liner) . SIDE VIEW - TYPICAL SAND FILTER WITH GRAVITY DISCHARGE SCALLJ/S' , {'-o' Note: See additional details on fOW-ISF -S-J Potent # 5,360,556 , @ 1998, Orenco Systems, Inc. Filter Sand (reler /0 sand grada/ian ranges on drawings ETD-ISF-SG-' & ETD-ISF-SG-2) ~ ~ ~-..... (II Orence Systems'~' Incorporated HI.I .\lIml\Y NJI'Nllf SUUllRUII, ilR[GOIl 97479-9012 rrL[PIIOf-I(: e).11) 451J-.I,WJ I'.A.C:.IMILl: (~).ll) .I~',~l. :~HI}.1 EDW-15F -5-1 Rev. 1.0 (2/98) Tom Noice 10/1/99 Pump Selection for Pressurized System . Orifice Size Residual Head at Last Orifice Lateral Length Total Number of Laterals per Cell Orifice Spacing Distributing Valve Model (# of Zones) Lift to Manifold Discharge Assembly Size Transport Line Sizel Pipe Class/Schedule 1 Transport Lengthl Manifold Size I Pipe Class/Schedule I Manifold Length I Lateral Size I Pipe Class/Schedule 1 Flow Meter! . Calculation Minimum Flow Rate per Orifice Number of Orifices per Zone Total Actual Flow Rate Number of Laterals per Zone Total Dynamic Head: Lift to Manifold Residual Head at Last Orifice Frictional Head Losses: Head Loss in Transport Pipe Head Loss through Discharge Assembly Head Loss in Distribution Header Head Loss in Laterals 'Add-on' Friction Losses Head Loss through Distributing Valve Head Loss through Flow Meter Size Pump for: TOTAL FLOW RATE TOTAL DYNAMIC HEAD 0.125 inches 5,00 feet 17 feet 8 2.00 feet 1 5 feet 1.25 1.251 inches 401 45lteet 1 .251 inches 401 20.001feet 0.75linches 401 nonel 0.43 gpm 72 31,3 gpm 8 5.0 feet 5.0 feet 5.5 feet 4.9 feet 0.7 feet 0,2 feet 0,0 feet 0,0 feet 0,0 feet 31.3 gpm @ 21.3 feet 7741 Mckenzie Hwy S;;' f7- ?6 ft ~ .??~ 250 I I 1 I '-1-1 ~30 :+te J i I~ ----....., I I I I I I I I I Effluent Pumps 112 Hp to 1 1/2 Hp __60Hertz 115/230Volt__ Curve pc3 I~. l \\ I \ -I _ P30 10-5 stage \ __I '~ I I 111i'-~ ! I~ I ~ ~i I~~), !=~ 1 ~ !- ----~ I'I~=~-~ [ P30 05 - 3 stlgeo ! .... 'I.~ ~ "\1''\ ~ i 100 -: ' I ~'-LI . [''-_~\_ ~ __1=: """,- \~ -\. ~ ==~ f~-=\~~- - =1 I" ~ \ ~ '\ I ___1_1 I~' 1'\-- 50 -t- 1 . 1'-. 1 ,-~ ./ : \-=..-'1 i I - J),I.'__ o .J!!!=~iTffi-nf~-~-! !+ o 1 200 -I I I I I i II .Available in 115V or 230V 1 1 - " " '": 150 :;: c t:. IT 1-- I-- I i I 1 1 1 1 1 1 10 20 30 Net Discharge. GPM 40 50 . EGGE SAND & GRAVEL L.L.C. CCB tll00n7 U(U'I/\ . ~ ("(-("",,,,,,., TESTEIl III _C-Hi TEST OESCRImOll . P~one 541-48&-15115 FAX 541-48!>-6532 90520 Coburg Road . Eugene. OR 97408-9467 S-. l S-. Ci q DArE TESTED . PUJIT [.All smVE ANALYsIS ~mple Description <; ~t\d P. Hu MtJ i ~ SIZE I RRTMNBD PBRCBN'l' PBRCBH't RB'I'AIDD PASSING . . 3/8 o '(0 ..11 ,~7.3 . LU- 110 '/(,r,tI_ 2~,S 't 116 I 2S"/.. L (1,) .S'~ '. f30 . J '35"'1. f'_~ Cj f60 tft;7. 3 zc4.~- I 4 - - i./.CJ f60 ' '71.f 10 flOO I 111. &j i./: 3 rAN ~o 2~ - JOh l Ll Cj{G, it 3- MINUS 200 WASH .. DRY WBIGII'r OF SAiIPLB , 'S 7S-' I DRY WRIGHT ~ u_ WASH I ~ (" r. '3 WASHING LOSS ",~ BTARDAaw - tutlWum 100 . 90-100 ' I ' 62-1oU 46-82- 25.55 5..i6 ().10 ~ J ,. J I (<'WA811 1mB WA'mR ( ) WASH ........ ......."10 AOBHT . .... .t.....'" OUB!/ty 99. " ,,,. . IJII(t COMtIllCl/on eerv1c9s 8/nce 1965. 2Lt~989:01 2~S9G8plpS 13n~9 ON~ ON~5 3993:WO~~ 9S:2, 66 20-d35 r -,. l0:39~d fGGE SAND & <etA VEL L.L.C. . Phone 541.485., 515 FAX 541.485.6532 CCB #106727 90520 Coburg Road . Eugene, OR 97408.9467 \ \ H,^-\J\ ck (""-~ TESTED BY \.o.-2..~~ DA TP. TESTED ~-u~ TEST DESCRIPTION PLANT LAB Sample Description SIEVE ANALYSIS S A~cJ ~'l \\ .L> r ,,,A \. \" VV\€.U\~ SIZE RETAINED PERCENT PERCENT STANDARD -~ REMARKs RETAINED PASSING 3/8 () 0 100 100 '4 72, I ('-0 9s- 90-100 .J. no I 3'19,,L ), (Ol~_ ~9 62-100 I 116 I 210,7 I Lj ,7 s-.1 45-82- I '30 I zs 7, 2 '---lliL 3~ 25.65 I -.. '50 324,L 22,1c 13 1)-20 I --- 160 <)4, ~ 5/~ 9 U-I0 I 1100 ~ I, <l I (o, <4 ? 0-4 PAN <-IeoS.1 5,L I ~.f~ \ I JLjJ&,Q I MINUS 200 WASH DRY WEIGHT OF SAMPLE DRY WEIGHT AFTER WASH [ ) WASH WITH WATER [ J WASH WITH w~T,TING AGENT' WASHING LOSS ~ ~} ,.._-~. r?r.--'""':'~~;~' (' ;-.-.;,....".! ~~...-2:-~~tti~L rt.,":--= ~ . b',.;j1\..~ " . ~'~--. ':J""~~;:3 -. ~~~;D'~-:'_....._.!!-..,_~ _:"h _....-.i....)~; :=~~~l..,~~...;!>j!..;.:.....~l'l:........~ ~~.~~~~.....:..:..- ~.:rr~~~,-~v~..~ ~ i~r~~~~s:~.~.~_.- ~.tt~t~jrV~~~~j~~ ..,o",~~_I(.~, "\iF........~ ~ '.;,..I .~,~~...~ -~ -~ - Quality aggregatas and construction sarvlcas since 1965. " c.~_..,~:... i'~, S :,~ ~.' _.; ,~~. "-:-':.:f~~"; i::..~s-~r~b.'''''\.l"_.:t~ _e,";;;l;'::r.;t,;wt~. "~l'.\';'f-"'.:r:-r\!I..\.!' '~,~t. ,"',0 :"'.~r.~h, .'S:\:.~J';:o~' ~ c.' '~f ~ ....... ,20 :391:<.:1 b882ZS'? : 01 22::5958I:-TI:-:; 131ltiCl9 OHI:J Orll:iS 3:)93:1.lrJCl.:l 60:!:'1 6660-' .J M~I~ 7'1 ~o .,.-J.Q.2./ ~\. 0';) ~> / ,.-// /' . ~~~ 'I;t'/ // '" // ," "'" _// "..-" .::r- ;(:~ B/ ~. , '. //-;;~ (,( ~\ / .~./ ' I~' ~\ . 10l.I' ~50 : ':; 5Qdl.'/t',7(, "su.lt I":\bo' \ .. .' . , gll;)Jil\~ 511! / " // / 22' 1 I ! i i ,/ I r \ .-\.-t w~w 30' I / ,?if~"~, \\l\l " /- -- " -,-..., ~ --n '" } 1(/ I .~ ~ ~ ~ o \ ( --- - / ~4' MAtJv rl'l (,,1" v~Fp ~) 11\1<. (lY/'~ ,( I, \ , \ , . \ \. \ '- . ...., \ \ ,-< (;.\u...J XN :" I' U I S€'fl~ I 7,-0)' &1'111.'" (rE' 2-2.' Br"~1'\ + rz~7(( ~ 77'-10 G, f/.'/fv e"k 5 pd"j f',~ 1,( /f'. 1'1t.t (, , tArt.. (/t:;t - '1)' 1- .,.. 17 oz.?. /&31].70 ,/ ./ r , .' " Qn.. ~~ IJ '!d -::- 110- r.. ~, '" C\J ~tJvJJ; o 1I,\~ ~cc.l-t /",;- (1/ ~( . . . HOLD SLIP APPLlCA TION:# SP 99-7380 LOCATION: South A St. Marv LaVasseve 1705 Minda Dr. Eugene, OR. 97401 lANE COUNTY ON-SITE SEWAGE PROGRAM IS HOLDING YOUR PERMIT APPLICATION FOR THE FOllOWING REASON: Your site requires a sand filter sewage disposal system, This entails submitting detailed engineered plans of the sand filter construction as well as a new plot plan showing location of the sand filter, drainfield, septic tank, house, well and distances between each item. Detailed plans need to include: top view, side view, plot plan with location of each component with elevations for hydraulic calculations, pump curve of proposed pump, and sieve analysis of filter sand to be used. William Martin SIGNATURE Seotember 13.1999 DATE Mondav-Fridav 8:00 to 9:00 OFFICE HOURS 541 682 3752 PHONE IF NO RESPONSE HAS BEEN RECEIVED REGARDING THIS MATTER WITHIN 30 DAYS THE APPLICATION MAY BE DENIED. LANE COUNTY ON-SITE SEWAGE PROGRAM Court House I Public Service Building 125 East 8th Avenue Eugene Oregon 97401 LANE COUNTY . \J\ ~ ...Q -P '" ~ . Typical Intermittent Sand Filter Detail Sheet l o PVC La/eral 1/8" Orifice at Top 01 Lo/eraf SIDE VIEW rap VIEW ttTANDARD ORIFICE SHIELD DET~~C Orifice Shield SCALE: r = /'-0' f. PVC Lateral /, /510/5 for Draining ^ c-6( 1/8" Orifice at Bottom -i }' '//' "I a/Lateral rap ~ PVC Orifice Shield ~ SIDE VIEW NON-DRAINBACK ORIFICE DETAIL SCALE: /' = /'-0' . Riser and Lid (optional Styrafoom insula/ion) " IF 7:'1" : ~ID~. ;. Automatic Distributing : ~ Valve Assembly Fram OSf [(fluen/ . . Pumping System " , DISTRIBUTING VALVE DETAIL SCALE: liZ' = /'-0' . "Polent # 5,360,556 . (C) 1998. Orp.nco Svslp.fT1C: Inr 4"- 8" J ~ ~ ~~ Cl!I L J/8" Peo Gravel Orenco Syslems<1!> Incorporated ~ 1/2" - J/4" Rock 814 AIRWAY AVENUE SUTHERLIN. OREGON 97479-9012 ), \ lELEPHONE: (541) 459-4449 fACSIMILE: (541) 459-2884 -' '\, ," Slalled PVC Underdroin UNDERDRAIN DETAIL FOR PUMP DISCHARGE SCALE: f' = /'-0' 2"- J/8" Pea Grovel 6" I 1/2" - J/4" Rack " ~" Slalled PVC Underdroin UNDERDRAINDETAIL FOR GRAVITY DISCHARGE SCALE: r = /'-0' / Valve Enclosure 8011 Valve , l-]1\ ~ Sweep Ell FLUSHING VAL VE DETAIL SCALE: f' = /'-0' EDW-ISF -S-3 Rev. 1.0 (2/98) "T~ I ! j.<;,o~<I'OO;"'~""'~':-~""':;-"'''''''''''''~~'--'::'''''-'''":'''': , - I, -'----~ ~~ ':T~~""_ ~ ~ . "CASn4C-$6C)__ ~ ~ A<<_~ ~ _~__~~~ 11'_- .. ........- --....- ,....-_..._f1 o..r..- t:-.:=!'t.~-I-' ~ Aa.- hn:- ~ r oo-r "'m-:/'''';';'' ert'r.r 2 ...""'...."~-......,, """"-.;: l,:",::-,~""~';'~'_~";':"'T..~-..~,:._..",.-".~~_.-:-.~..~,..".....J~I ....- ~~-= ITT.. . ( IUMr ... u,: l.:-DiLribbtA....CriJoOf wlbldill,lidand ,pol~...tclor~ . /l JO.Die."f."",,~11.XIO,,-",~4,? tI/"""!l"~.''''''''J6' ! .A:rtU~"I~~.....,ull.4;"'JH~M,"'F.! 1..1<f....'Iu_' SkIpc..lltWlW1J~tid \.. ~JJwlIHU"_.""fi=",,I_.nu,J' .... . ~ .- ~ .... I' p\C"';c:ft""'......, , ~ i IUurJTnlr.a4aplcr: "capII P\C ~ "1'fi~ ~"\ f C:.alMO_..tor~.rtoriKt '~J"<'_':':';-,-"'" ,r-'''''''U ,,' "'r'.....'~....J......"....'''~ .,. _"j"'" l'~ / (...,.fU".~ I ~: - ct",,~,':.,...,.~n s,.'M'~rvC . F . ~ ~ ~ - .,..:!J \-1 .. tJl'fil><"w'''JUWpt" Ijns"CUl"'''' _ ......... .-, . ._.~.;--., 11'. WI.t,-.bd'i":J . .....t-===-~11' I '-r.'~""", ~ .......1 ~ I . 'II "rl'I~-.~....~'-=--::-\'~~II-- ~,' f~ ~ _=," . ~::"".;..:"j~~ "'A-'S, - " - ""_........_ 0\ . II:.)/i....' ~...___ ""COtac>Pf'O'"od L --1.... ~~ . I \ &J'T~. ,"' , .-L~' .".,,'... 'i I .....,.U-u. : 1S"'ta," It -L -1 ,=.:--:~~.~J~.~.r;~~~_~.._.." f- ....... -1 TTI;lCr{rnI_! TOP \'lEW 6-=!' r P\omp <<"inl uMmb!y A.O,Opl;_1 . . ,}~'~7i.. ofLL r I j '-""~'''~'--~'='-.J. i rcw W ". -1..Mi........,.L.apTtpicallIl olI=ma'1lDtwt.aaooll SIDF. VTF.W 1000 GAt.LON TANK . ~ , ". _11":__ol--a i.,a_lrleip. I II'~' ! -l }- >1" I ~~J I ". ThlHIEW Gtn(ral~O(tS: r~tt"':=a: TCI>I"'~~ Orcnciac\"~:...,.,,- A..np..........fuIl""';>do:~ l'....ooI_.~~I6qd:~ LMIls: To,...&OQpd' L-n.lL.crad-'C&pct' c-.."1Iod1.o:>d.~~ n..M;.ci<aIII:"b<_C1~et.idosutw!;"lloMlo\m1IlI~~.r.ia ~.60""~I.dutlOl......u:.Itlf>ll.w"'datll'CUl>d...r..U. Soil~" IXlO pl(r.~~.._~,,"",," ku I/,..;J/H&I'iIt, is ~".,..."",I, CMcme: "'..~...wbo:aotalbb~brf'l""'l~I~. k...ror:M{....dulllorA.Sn.IA...'Gndor60."..600.000roi. n..CO/lCftO<"""a.."",_I~~IIIn.rt/lol~.OOOp$i...!1 d.l'I;r:.I.ooo,.o..eo..:.<lC~"ra4''''I''''''''_Nn>otorm''l. .uDlC.L\O. T~11. ,....~br..........ot....ku1h.l.asil ond_~r tt.~,r<<~l~~.?r~~,~~~~., ilf"U"'6IIro."""",:-ClfW...oo\II~.....n:.l>ibl1.Nn.lllIId ......oni,'-':D"..btll:::~......,1EUf'<isoopUoul. TWlP:oll...-"lr'llIllUw~I......o..jotlJi"IIfIU'lM Ullk1o.ur-odw........nI4l:"-or1o.u_lood~oIu..."...ip """"rD- hopcr..;"J~_llcll:lallO.......DWl.i:lllwW. tJuUllll_I~""""~CIt.W1lt1O'loIfrlaCCllnpliafta...w.1N -...r~.-d>rdI""~oI0rq0a'I__NlcI)aO.711/'1d7]. All UIlkIJlllil"_k.-.:l..aiai_)-.n1llict.~$.>DdIllf~ rn-tw.....~~lr____Wc.. n.buo~llclUb&c'" ..r-."'._eqRftlurioll_'lkCW:~ WWlaiou~ JO_ba.II:a"'~_-r~"'*"-"~~ .....,......... .. _ --. A..........._<Jl11 l.:lioQia ftqIin:Il_..IIIIl.....uIOlllljaa.DCI:IIiou/Ii...wtoor:db41.. TOIl: TMbstt.ll(.........califood-..:ni(k.....o-.po.SilltIM.I)aO.71....n. o..Aac: t:looiof...........uzed_u_lioalulClbJ'Cntoa--.hcrula).:O.71 aN'), ),w.lma,..-_ptIIjco::IaIdIIlytlow: 10';, III IIIOCffilIcn 1IIf2O'Oo ilw.cra,plarioftl. ~....,..,.tr-.a.aIc~Ibi..WIllOfpnL "-wl.ti~t 1rn"'~~"""''''G.irr'''''_,,,,,,,, TIat.Mortj"F PIx......._'Oc..;.pa-_..t.:c_lllc~ u,.w~.....Ltm..DL MaIloftl*tQ.:-.:!L.- Mu"twtcdt.~ o..~_ ,."..-.:- .~~. iI..l1Eb:7S'lS ~M .,." rtDle:__..........6! a.-_.... 5...........,.......... ........'" i709-9012 ~~o;cl....'s <.i .s ~ < en ~: a ,~n 4..) a.... ! !Il "l'" " ~d jj i I ~i~ I ~ ~" 'I E . .!!1 @ i H, ~ ~l~~~1 li il ~....~ Pi.buc. \\brk!J RECEIPT NUMBER: PERMIT #: TYPE: SITE ADDRESS: PARCEL: APPLICANT: Sf(~\~rf- ~ 2000 2100 3065 4010 4100 - uescription . LANE COUNTY RECEIPT R99004787 SP997380 Sanitation--Permit . POSTED ON: 09/02/1999 17-02-36-30-01300 SUB-TYPE: INSTALL PECK BRIAN 7740 S. A ST SPRINGFIELD OR 744-6937 97448 LCPWRLH Description Amount \ New Technology Fee Administrative Fee Long Range Planning Surc DEQ Surcharge Sanitation-Permit Review 976.00 Current Pymt 10.00 117.00 39.00 30.00 780,00 ~-I~-eqJ o/'7b~. e5'/'-o/7'..7.5'cfo (aane REQUEST FOR ASSISTANCE. ::=~' 1S.f\. I ounty LAND MANAGEMENT DIVISION 125 E. 8TH AVE., EUGENE, OR 97401 LiL _ . ',,-,:, "- /~'S""'J ~"- l'ubU, Works Mail Permit To: f./~ /...- I <'?~ Na . 170s MIJJp,t} _O.? Adtes. (,) ~ r-::' ,,/C" j} v- City State I Please complete all lines inside white boxes. (Incomplete requests will be rejected.) f3r(/",~ ..,- e"'ld/~. Owner of Property ~~ 7 '1" -(p 'i~1- Phone ;;.. ~ '-(,') er ddress ''//'' P _?,t7""':J(1,~fl ~J.{" ~'f3-~o~ ? Phone ,C; Q, q Q'J ? lip vl::J.d t' 1/ --L7 iJ )' Your Address /vi IN Olt . 1/a- C,J!?,('".-// ,t7'7'rDI Zip I-I~,,... ~"'t' t O"u...fr./Lf,.~ Ivti 91{ .J,? it ~ -5::)'3"5 Contractor/Installer/Builder Name cee license # Phone' Proposed work: -r:??J~ (' ~,;.::7 /--;z..,~ MAP/PARCEL NUMBER: (Found on tax maps in the Assessment & Taxation Department) 1'7 f)'] ~~nge Existing Buildings or Improvements on the property: House Barn Garage Mobile Home Shed Industrial Bulldlng(s) Commercial Bldg Religious Building Public Building Other: SEPTIC INSTALLED Ves BP/SP# No SI# '-f ,') - 'LlL Water District Well ...K Ves No Va~tion of proposed work: qOJD /'t ...... ,1,./&-1,,_ :7." ; , ~ Directs to site from nearest major Intersection: /l.(t1-i~, ~'t/(z.(,) /" 79t~ Y iyhf -k)n ''[J'' 1"1j41- ,'L. t;<~" -I ;j ,., ....~ }C;; SectIOn Jb.. ,~.,~,~ Township Section la:dol Y.Section Range Site'~'lrtt~ ~o. IA" , ->/71""'''' (.),/// . ---- - For Moblfe Home Placement Only~ Brand?'---... Size (L&W):------. Year: /' License # (No starts with Dista In feet ............... from MH to: Water: Septic/Sewer~, The signature authorizes the applicable programs to review this application and assess fees as determined by Lane Code. The signature also signifies that this does not mean that an application has been made until all Lane County programs and applicable state divisions have reviewed the submittal. The above information is also certified as true and accurate. I realize that false information submitted is grounds to deny the application. P-~?I Zl t Sign~,J /~~~ Date: q - Z - cf of LMD staff can NOT be held responsible for evaluations based on false, Inaccurate or Incomplete Information. Completed request accepted by: lCPW l~9 , , Date: