HomeMy WebLinkAboutPermit Septic Tank 1996-06-27
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If this 'report approves. useAof.:a 1.sal),d ,fllter,.or,'.pr,essunzed ,dlstnbutlon..system, '.detalled. construction deSign ~plans ,. ,',;' "":
will be required with 'the 'installation . permit 'application. .. ,:...... '. ,.', . , "
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TRS, TL 170::21 (03 0
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Subdivision:
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THis IS :A'PRELIMINARY: REPORT :WHICFr:DOES :NOT, *
:ENSURE .THE;ISSUANCE.OFA 'FUrUf.lE .BUILDING" :
PERMIT. : ANY." PLANS: OR ':EXpE;f::!D~TUBES ::MADE,IN' ,;, *
RELIANCE UPON THIS REPORTr'ARE f~X .YOUR .OWN .:
RISK. IF S;ZTE'SlVED, SEE"'~~E S",E, , """",,..:,
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" Jbr- '-->;fv (Z 7//16 ::':?;<:; .
, ~E?:,A00.RiZ.ED' AGENT ' , ,-< DATe \.:".." .
~~.~. COUNTY ENVi~9,~MENTAL HEALTH, 12~ ~sTli'rH,A~:ENUE, :EUGENE; ORrGON 97401 (687-4051)
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wARNING:
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'<Thls Site Evalujltion is 'a technical r,eport to determine. If a on-site
.; system .will function property. It does not approve the proposed use of
.':the' parcel. This Site Evaluation may be converted to a construction
.;' perin it onlY'if the parcel and use meet land use regulations in effect at
.. ,the time of application, YOU ARE URGED TO CONTACT YOUR LOCAL
, 'PLANNING OFFICE FOR LAND USE REVIEW.
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'. :. Date, Postmarke(l',,,,,~",'"
: :"Date'H.nd:i1elivered~i~~~li\"
:,' WateImas'ier"Ini'tiats'ii:Wl~lL~'f.-m -
. ~~ "',~~;l~ms:.~:tlWm:~,rlii-~~j'ri'
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',.\ifNDaieFeii"Rec'eived'4"" .,..
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Check No.
START CARD
NOTICE OF BEGINNING OF WELL CONSTRUCTION
(as 'required by ORS 537.762)
I'
This form must be completed, signed by both the owner (or authorized agent) and constructor, and the original mailed or
delivered to the Water Resources Department. 3850 Portland Road NE, Salem, OR 97310, no later than the day
construction, alteration, conversion or abandonment work begins. A $75 fee shall accompany all notices for new well
construction or conversion of an existing hole not previously used to obtain water (make checks payable to the Water
Resources Department). Notices meeting this requirement but received without the required fee will not be accepted as
properly and timely filed. In addition, the constructor shall prQ.vide the "Watermaster Copy" of this nalice to the office
of the district watermaster within which the well is being .cd'nstructed. altered, converted or abandoned using one of
the following aplians: (a) by regular mail no later than three (3) calendar days (72 hours) prior to commencement
of work; or, (b) by hand delivery, during regular office hours, no later than the day work is commenced; or, (c) by FAX
no later than the day work is commenced. If this method is used. the original "Watermaster copy" of this notice shall
also be mailed or delivered to the office of the district watermaster no later than the day work is commenced.' The Water
Resources Commission has authority to impose civil penalties for failure to submit the required $75 fee with the start
card and for failure to submit cards prior to beginning any constniction, alteration, conversion or abandonment work.
\\'30
56'-\..-\."'-
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Owner's name and mailing address;
SR'< .. ~(
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'17'7/tJ
Fee {~ew construction {D Alteration (RepairlRecondition)
Check type of work: Required 0 Conversion ~~~ 0 Deepening . .
o Abandonment OriglDal Start
Card Number / /1'
Proposed Commencement Date / /- 27- 'l'S" Existing or Proposed Well Depth Lct:J ' Diameter <n
Ch k U ~omestic 0 CommunityO Industrial . 0 Irrigation 0 Monitoring
ec se: 0 Thennal 0 fujection 0 Other .
Proposed Well Location: County Let V\ e..:, ' Owner's Well Id. No.
Township
/7 - 5
(NorS)
Range 2. VJ (E or W) Section 3 h
I. 5. W ~ 1/4 of .s. . L.tJ, 1/4 of above section
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2. Street address of well location I ~ o. f-\
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3. Tax lot number of well location
/300
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4. Attacb map with location identified.
See ~verse ~f this fonn for approved maps,
5.'. Show well location within 1/4, 1/4 of section grid at ieft.
. . ~.': .
We hereby certify that we have read the back of this fonn, and 'that to the best of our knowledge the infonnation
ptVided herein is accurate and the well is being properly located from septic tanks, septic drain fields and other
h s. (See #2 on back)
/_ " (}J\IV-~ ~ \J;)Jv- , " A v,A- ~ ovo., ~ e", .rcy:=..
iJ 7 ~ner's lignature or authorized D.jent C BondejJ )Va~lMo;itor Well Constructor
,) L '. Ow'\' '75) - 11.2. \ License No. ((0 t:.. t.p
Home phone W~rk pbone
companyM~K~'> W-e\\ {)'f:\\:,,'}c..O,
~
NOTE: This is not a water right application.' The owner is responsible for obtaining a water righttbrougb the
Water Resources Departmen4 if reqnired.
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:;t;_.~.(_~~lI>''o~~y..''di''::*''{. .',;....;, ....'c:, - I.'.: ':U~J ....,~OOP:;y. . < 'STOMERl\', .;..:.('.;~~;.-tt~~~_1~::~.~..b~7;...~~\. ~n~;;'~;"" :~'"
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STATE OF OREGON
WATER SUPPLY WELL REPORT
(51 ""luUod by ORS 531.165)
Instructions for coffioldln!? this report are on the last Dan DUbis rorm.
(1) OWNER: '~', Well Number
N.me Lo\.('''''S A O~ \ b~... \<,
Addre,,"'1"I "',:",...I.l_, UV',J .c;4-
~~;y ~~i'6~~k~ \ -' State rv.._,_, Zi,qIJei?g
~ew WcU 0 Deepening 0 Alteration (repair/TC<Xllldition) 0 Abandonment
(3) DRILL METHOD: .
o Rotary Air o Rotary Mud ~ble OAugcr
OOther _
(4) PROPOSED USE:
~rDomestic OCommunilY OlJtduslrial1: Olrrigalion
o o Thenn.l Olnjection' [Iljvcslock nOlhcr'
':(5) nORE HOLE CONSTRUCTION:'" -'.,
". __. ".: Special Construction approval 0 Yes 0 No Depth of Completed Well ~ fL
" ,". Explosives used 0 Yes DNa Type Amount
HOLE SEAL
. '~'J-' Diameter
a~1','
I" ~ "
',". ," I-
From
/")'
1<'
'/)-r.-'
To Malerlal From
I~ f'lp,,J-il. ",'
J^nf
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To SacJU... poul"'t
n' '?o... 5"...1;(_
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How was ...1 pl.ced: Method 0 A 0 B [gC 0 D
o ",..
Backrillpla~edfrom _ ft. to_ Cl.
Gravel placed from ft. to ft.
(6) CASI!'(G/LlNER: -
,
Liner: " II
Material
Size of 'Jravel
Plastic: Weldrd Thruded
0 0'" 0
0 0 0
0 0 0
0 0 0
~ 0 0
0 0 0
Diameter. From . To . Gau&e Sled
Casiog=-':>" ~~.2.1oj ~
10
10
9~~~B
Oin.lloc.tion of .hoc(.)
7) I'ERFORATlONg,i;CKt:t:"S: '
',':, .,,{ \;ij1'erforalion. Method~ \.... ~
..,.. OScreon. Type
5'01
To. lslle,. Number Diameter
qs-~c., ~c:- c.."
9x' "l,'(/.." 'In (",'
From
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Oi!, ':',in'
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Material
Tclelplpe
silt
Caslna
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(8) WELL TESTS: MinImum testing time is 1 hour'
o Pump
i
g.6ailcr
Drawdown
(1\ '
1 hr.
o Air
Drill stem al
Flowing
o Artesian
TIme
Yield Q~al/mln
~- C. PI\o\.
Temperature of waler <;1 Depth Artesian Flow FOWld
Was a waler analysis done? 0 Yes By whom
Did any strala contain waler not suitable for int.endcd use'? 0 Too little
OS.hy OMuddy OOdor OColorcd o Other
Depth oestrala:
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.
(START CARD) #!Za+Lq
(9) LOCATION OF WELL by legal description:
Counly ',L.4 .^ "",. Latitude Longitude
TownsiUp-t;7- ... N or S Range '-?_ u I E or W. WM.
Scctioo ~(~ N \AI 1/4 <' \!J-- 114
Tax Lot !11"V1 Lot ~~Ock Subdivision
SlrCCtAddrcs...Well (ornca=t addn:..) ...!]...'1...... 0....1 c:..:, A,
(10) STATIC WATER LEVEL:
,. ...!J... "':J ft, below land surface.
Artesian 'pressure _ lb. per square inch.
(11) 'W~!ER n~AiUNlj ZONES:
D.te 17-2.o-'lf"
Date
.,........
Dc~ at which water was first found . Q'1 I
, '
t' From To Estimated Row Rate SWL1
~' ~{... ~-c. P,W\. ~
1 I 1
I 1
1
--
DE
(U) WELL LOG:
,
. Ground Elevation
t.rYl'
Material
B..L~ r b.....
6_..1 .{.<.,-'< ~
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From To SWL I
O' An' I
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Date....wI ,11_ 2. 9- 9<;"' _ _ Completed J - q - 9-/~
(unboaded) W~ler Well Constructor Certification: - --
. i :~~ I certify lhallhe work I performed on lhe construction, ahention. or abandorunent
of this well is in compliance with Oregon water supply well construction sandards.
Materials used and i~ormation reported above are true 10 lhe best of my knowledge
and belief. ..
WWC Nwnbcr
Date
Signed"
(bonded) Waler Well Constructor Certification:
. I accept respmsibililY for the coosllUction, ahcralion, or abandonment work
pcrfonned on lhi.s wdJ during the coosuuction dates reported above. All work
perfonned during litis time is in compliance wilh Oregon water supply well
constructi(l'1 standards. lbis report is true 10 the best of my knowledge and bclier.
, WWC Nwnber /C,7 c;
1? .J\~,(") Dale l_V_ 9k-
croR THIR COPY-CUSTOMER
ORIGINAL & FIRST COpy, WATER RESOURCES DEPARTMENT SECOND COPY-CONST
Signed
'.'
..
.
OREGON DIVISION OF STATE T,A~
775 Summer SlICet NE. Salem OR 973 ~
(503) 378-3805
~~: L~e,
'11- 0 .;2'13
ONSlTE WETLAND DETERMINATION REPORT
For the Purpose of Administenng the State Removal-Fill Law
At the request of the towner orhislber agent. an onsite wetland determination bas been conducted on the property described bel~w.
County: ctlo\c.- City: SfYIh.\~'e(d..
~ Agent Name & Address: kvrj D / l \xct:-'
. ll~ c,.. 4).~ st. Sr....~.etcl, ol'.'q1'i7~
Township: n" Range: 2.. IN Section: 3(,.,. Tax Lot(s}: 1300
Project Name: . Date of Site Visit t.t / 1 / 99
Location: WeSJ, * 1 'I*' .: ~S~ of N~~lo'\5ic *"::J
?i. There are no jurisdictional wetlands or waterways on the property. Therefore, no state removal-fill permit is
T' required. Notes:
o There are wetlands anellor waterways on the site that are subject to the state Removal-Fill Law. A permit is
required for 50 cubic yards or more"Of fill, removal, or other ground alteration,
Notes:
o Awetland delineation will be needed to locate and stake the wetlanellnonwetland boundary. A consultant list
is enclosed.
o A permit will be required for
~ No permit will be required for c.c....s+y\.\.c...t;o...;. 00'\ '*"'- Q1-e
~f W~ANi< CtfC "* fv'c~ .
o A permit may be required by the Army Corps of Engineers [(503) 808-4373)]
Comments: It r.1......."""oz.!. ~ ~~ I,.,ce.... mis./>,jLppal ""'^ -4-l" ?'" V'<.L\ 6"" ~ loca I
Wl".. ~...l.. -C'" aJ(~r..A , r'\ sL ~-kH- wd \ c~f.J.. -h- \"".."k. +k., ---"'''flnaA.. COlla;{-
~b ~Of\., ~(" ~:7'~ Ol'\ ~ LL11
Determination by: An ~ l.?.ll~ Date 0 / <1 /:::EL
Copy To:
DOwner/Applicant tilEnclosures: lJ..Ul I\'\LL.P Co.l€r,lci-!<.l
o (A~ ().!- ~~'-:~J/~ H, ~~7jC-V" , Planiring Dep.artment
o . ,Corps of Engmeers
o LWi ~;\c..
o DSL file copy-
1-':
.-'~':.: ,::.. ",{~';':'::,?:~~~~~ J;f~~~.~~Y~~:~;Vf.~.~':Z~~~~}&t~W~:~~~~L.~$~P, ~~~~~.: '~~~~~0~~;:~';' '.,
'Regulated?qYes -,0 Nq,;:\])~tl#c;" .:' h, .;,,.{',fl~.. .,.0 ;:l ({3",t,-,."
. ..; - ,'" 'N~, ~,~.d'~~~~,~J,-:':.':.:;~:~.','.:.' ~.:!t~~;'~~,~~~~,~1~~~:":~'. ;:<~:F:~::~;:J. ':,' , .
. .:' ~..',~-: .:. .~~.: .L..::...,.;.~':'~;:,'~; .... " ,:,':'::".)~;"'.:'
.. :NWIQuad::",',. - ,'.,."
'.
.~}i,~._ '.,.
'"...~, . ..
. 1 ~: -' ;.,:
Wetland? 0 .:(es.O No 0 M.aybe
;/.,." ,.1
, ~ ".'
Waterbody
All Wetlan& on NWl? 0 Yes 0 No.
Received:
". .'.
:LWlareah.,,
". '," ~ '; ~.,.-.,
',- ,
In UGB? 0 Yes .0Nol',PCD ,
, ": ",,::';"1':';":;(," '....
I" ' .. . . .
_ ,'. ',:.~.1'~~~'::,,:: - ~ '. '}'/ ,~'.': . ;:::,'~.1 _.~ '.'
" ..' ",',. :'", ,.-.".,..,'..." Ou.Lyil?,.D,Yes.\D No,...,
FWD . .~:;~::~;~,'~"!~';',;~W;5,::~;,"~;~i;.!'.' ,. ,. :;'- '::~,
Ag.Land?O Yes.O No
I
3198
-,-
\\Salem I \Pp\W~ti~nds~nns\onsite.doc
. M-14
33,5 ACRES
wl f1J
...~'
PO'"
CIl
~ r--
-
f-o
U I Y Of
, R 03 iY
CIl
<0
-
,. 9rl~
'-. -. ,-
II 12
16 I~ I'
13
21 22 23
2.
28 27 26
2~
33 3' 3~ 36
--.-. "-'-.. . ..
... -
. 3 2
1
9 10 11 12
-
16 I~ 14 13
.. 11
f-o
M-14
1.'3 ACRES
LEGEND
SC,
~
~
---
-
CJ DELINEATED 111
.... (with DSL DeU
.. -.
i...... . . ..":1 DETERHlNED 11:
----
~.......,.
.-
. .
I,'
,I
('
l'
..
OFF-SITE Dm
,,00-
1200
~
~
ON-SITE DEm
I
'500
1)~
MITIGATED m
I
1600 ~
""."""=.....,.'" Lln S11JDY ARI'.
1IE1UND ClASS
PSS 1IE1UND ~
(5-22) UNIQUE CODE I
RIN - RIVERllf
RLP - RIVERIN
pro - PALUSI'J
PSS - PALUSI'J
PEN .- PALUST,
POll - PALUST.
+ B-14 TEST PIT LOCA'
U UPlAND AREA
- -.- - - SECTION UNES I
+ SECTION CO/!NEj
I 94'. I PROPERTY 80m
NUHIlERS
~n--
r..;.;:;.Zi:..;.;.%''j RIVERS AND STR
~.~ ",:~..~~~\....\' em UIUTS
1500
1400
i
---:- --
--- '
--
"lOll
'1~,\,1t!:"-i .-';1.' ~1Jt '~"b UGS
41 ' NOTES
M-IO
2.8 ACRE S
"100
I. IIASI! NAP mOll LCOC DI
(STATE P~.COORDlNAr. I
'-
0-",.
.
APPLICATION AND PERMIT.
CONSTRUCT APPROACH ROAD
PERMIT NUMBER
afT "I"" ",
1r
HIGHWAY NAME
McKenzie
HIGHWAY NUMBER J COUNTY
1 5 Lane
BETWEEN OR NEAR LANDMARKS
948' 6" west of 79th St,
APPLICANT NAME AND ADDRESS
Larry Dilbeck.
1130 So, 42nd St,
Springfield, Or. 97478
05A35623
. ;:~~'::~~~;;:;~ j-,7:v::.i
I MilE POINT .
8.36
I SIDE OF HIGHVVA..
o NORTH 0 EAST
r;<1 SOU]1' n W{ST
I REFERENCE MAP NUMBERS
48-14-15
...... --
I BOND REQUIRE!} nE:/'"l:l1cll/i.:c;
o YES}l' NO OAR 734.5~25Iel
I INSURANCE REaUIRED REFERENCE S ADMINISTRATIVE FEE
,. ~ YESO NO OAR 734-50-025[31 0 TEMPORARY DEPOSIT
I AMOUNT . I OtECIt NUMBER
50.00 4575
DISTRICT MANAGER OR REPRfSfNTATIVE DATE N'PlICATION
APPROVED
380+ 85.99
APPROACH TO SER\";
Residence
TAX LOT NUMBER
01300
~',uu;..-; v~ ajUND
o
TElEPHONENUMBER~:fI;41 726-9064 X..../" . ./ dlc /7 b
Y' '/N ""'~J'{/. n'?A~
APPt'CANT ~ I APPliCATION DATE I APPROACH ROA COMPLETION DATE:
X ~ f(,~ ?-I"lh, I OJ "I REFERENCE: OAR 734-50-05014) 2-19-2000
The applicant cr are. that hoilne Is the owner or __ o' p. real ~roporty adjoining tho above described highway IInd has the lawful authortty to apply for
this permit. When t 'I BPplicmon I, approved by the o.p.-trnflnt of TRrI&pOrtiltion. tho appUc.,t I, subject to tho term. and proviltonl containod heroin and
IIttKhod hereto; and the term. of Oregon Admlnlstr.tJve.....RuIe. Olapter 734, Division 60. which Is by thl. reference made e part of thI. permit. Cople. of the
Aulo may be obtained from the District Manager'. offICe. .
Issuing of pennlt. under thelll regulation. I. not e f1ndlng of compli~ with the st:Btewlde planning gael. or the acknowlodged comprehensive plan far the
MH. Pennlt. ere 1.1UCId subjec:t to tho approval of city, QOWrt:y or ather governmental agenc:in having oIthor joint IUpervlskm aver tho IOctkm of hluhway or
authority to regulate hmd UlCI by mun. of zoning .-.d/or building regulation.. It shell be tho applicant'. nnpansibUlty to obtain ~y INCh approvel Including.
where epplk:sb~. local gawrnment detennlnation of compli.-.ce with the netowlde pl.wng goal.. (OAR 734-50-0551
2..-2. ~ -Pf'
SPECIAL PROVISIONS
,--- If the proposed application requires traffic control devices and/or special road construction, the applicant shall provide a copy of this
application to the affected local government. The original application must be signed by the local government official.
LOCAL GOVERNMENT OFFICIAL SIGNATURE
X
I TITLE
I DATE
2-Within 48 hours before beginning work, and after completing the permit work, tho applicant or his contractor shall notify the
District Representative at telephone number: 726-2552 Or FAX. number: 726-2509
3-This permit is to verify and allow access to tax lot 01300, When legal Bcces is available from future
South" A" Street, this permit becomes null and void.
TYPE 2 APPROACH ROAD - PAVED
R/W L~n_e..........
t-W--1
) uu \
DR/.
Ditch Llne--..,;
, -
Dd
I
'-Edve 0' Pyml.
H.Y~ t,
""
\
-~
PLAN
I NOTE: AU m8lerial and workmMIhip sh.a1 bo in accordanco with the cummt ct-'-o
of Oreuon StlQlard apec:lflcatlon. for H~hway Conmuc:tion.
IWg
20' I A g 90'
20'
18' R,g
R,g
IDpg 15'5" D.g
I CULVERT PIPE Ii 'QUIRED7
ll/lYES 0 NO
I TYPE
. COMPo or CONC.or APPROVED PLASTIC
I DIAMETER CINCHES) , LENGTH (FEET)
12 38
I SIZE AND TYPE :OMPAC II:IJ I nl\"..<NESS CINCHES)
STONE BASE 1 1/2" 4
SIZE AND lYPE :OMPACTED THICKNESS CINCHES)
11'
24']"
DRoW
I STONE LBlEUNG
COURSE
I ASPHALT
CONCRETE
PAVEMENT
3/4-0"
ClASS
2
:OMPACTED THICKNESS ClNCHESI
.C. or -B-
4