HomeMy WebLinkAboutPermit Septic Tank 1996-06-27 (2)
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, v SEWAGE DISPOSAL SITE EVALUATION
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j"OO Job Location S. 7'1 '" S+ 'C 'S ",",,~h A st.
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Lot Block WATER SUPPLY 0.... oOo>e.~ ~c. \ \
APPUCANT'SNAMEANDADDRCC>C> Lo...vv,", \)'.I..\,,,~10... \\,0 50""'''...... +;2',,~ <~ <.....lll O\rC:c,,,~ Phon" 7~1.-9ols>4
OWNE-R'SNAMEANDADDRES~l..o..vv~"\\~\.\.,,:>\""'- \\)0 <.,,,.....~4-:t""~..,:,-l <)~I;, 01r"5""': Phonp7~(,,-'ioiD4-
STRUCTURES NOW ON THE PRQPERr!- "'!'Iv-.. ~ .' PROPOSED USE OF PROPERTYS". ~.l\' \<'-:\'t ~<S a'~~l
I hereby certify that the above statements are true and accurate, and that I have the following legal interest in the property: "'-- nwner of record; --contract purchaser; "otential
buyer;
----1"ealtor or agent I further certify that (if not the owner) I am authorized to act for the owner of record. and~at said o~ aware and approves of this action.
.STHOLESREADY 't:~S . Signature d~ \\.I'\:~"Dat. sjS".e+J9T
* .. * * * * * * * * * * * * * * * * * * .. * * * * * * . . * * * * OFFICE USE ONLY BELOW THISLINE * * .- * * * * * * * * * * * * * . * * * * * * * * * * * .'
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THIS REPORT IS NOT A PER~/7.;~ SEWAGE SYSTEM INSTALLATION
The area descwpe9 onthe attached plot j:jlan dated ,~~.~ is .4fI"IZOUr';O for a
~ r.::::t./ -C'&:-Y\.... "ystem,
ADDITIONAL ~OMMENTS: -uf O;Z/~ 'Df2>1-twFte-uo
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NOTE:
_ this report approves use of a sand filter or pressurized distribution system, detailed construction design plans
~ill be required with the installation permit application,
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* * * * * * * * * * * * ... * * * * * * * * * * * * * * * * * * * * * * * * .
* *
* WARNING: *
* *
* This Site Evaluation is a technical report to determine if a on-site *
* system, will function properly. It does not approve.the proposed use of *
* the parcel. This Site Evaluation may be converted to a construction *
: permit 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. *
* *
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
THIS IS A PRELIMINARY REPORT WHICH DOES NOT
ENSURE THE ISSUANCE OF A FUTURE BUILDING
PERMIT, ANY PLANS OR EXPENDITURES MADE IN
RELIANCE UPON THIS REPORT ARE AT YOUR OWN
R'SK." S;?tfJPVED. SEE REVERS:(,:7/!h
, ~Ed?~RIZEd AGENT DAT~
LANE COUNTY ENVIRONMENTAL HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 974D1 (687-4051)
C55-32
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MEMO
TO: APPLICANT
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FROM: LANE COUNTY ENVIRONMENTAL HEALTH
SUBJECT: CONDITIONS OF SITE APPROVAL
Lane
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1. .Any alteration of the natural conditions in the area approved for the on-site system or the placement of a well within
100 feet of the approved area may void this approval. " " , ,
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2, This approval is given on the ,basis ,that the lot or par~el>described"above .will not be further partitioned or subdivided
and that condition~ on' subject or adjacent properties have not' be';'; . aiter';d in any manner which would prohibit .
issuance of a permit in accordance with O.R.S, 454.605 through 454.755 and Administrative Rules of the Environmental . ';'
Quality Commission, Any such subdivision, partitioning or. alteration may void this report..
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3. This report is valid until an on-site sewage system is installed pursuant to a construction permit obtained from Lane
County, or until earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department of
Enviromental Quality to the owners according to Department records or the County tax records, Subject to the
foregoing, this report runs with the land and will automatically benefit subsequent owners.
4. Only persons having a valid license issued by the Department of Environmental Quality 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 person other than the above
perform the installation.
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Applicant to It.- f?!~'t:-/c. Date r /; z:./tJ)
Tax Reference
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SITE EVALUATION FIELD WORKSHEf.'I' .
5.1.115"'- 2.""'1
evaluator
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Parcell
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Use
Parcel Size
Water SUpply: Well COllllUllity Public
Soil Ma~ix Color and Mottling (NOtation). 'Coarse rraqment5, Roots.
Texture Structure, Layer Llpitill.q Et~eceive Soil Depth, etc.
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SI:Sml mCIFIClTIOl/S
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Typo Sy.tal:
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HOLD SLIP
NAME
ADDRESS
lanE
County
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<?'A7-J3, d7.. Q7c/77
, . ZIP CODE
APPLICATION /I qc;- Z79
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LOCATION
The Lane County Building and Sanitation Division cannot proceed with processing your application because:
1. /[j Incomplete application (items deficient).
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o Address and/or directions to application site.
o Proposed number of bedrooms in dwelling.
)~)' Approvable plot plan (see attachment).
o Notification of date test holes will be ready.
2. 0 Verification of existing system required (see attachment).
3. 0 Two test holes (2'x4'x5' deep) required for expansion or repair of existing sewage disposal
system in the area of the proposed drainfields.
4. 0 Other:
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SIGNATORE
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If no response has been received in regards to this matter by
the application will be denied.
LANE COUNTY ENVIRONMENTAL HEALTH SERVICES
Courthouse-Public Service Bldg. /125 E. 8th Ave. / Eugene, OR 97401 / 687-4051
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950279 DATE 090695
SPRINGFIEl..D. CmEGO'.
LOT BLI<
o UNITS 001 STORIES IBLDGS 001 PHONE 726 906~'
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