HomeMy WebLinkAboutMiscellaneous Sewer Connection Record 1978-3-6
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Lot . . . Block . lJ - /
SITE FEASIBILITY REPORT FOR SUBSURFACE AND ALTERNATIVE SEWAGE DISPOSAL ~ S'?I j(
APPLICANT'S NAME AND ADDRESS 9 fiAJ!. ;/ 7rJC '7~//) Y7...U ;)7CJ7 &/J;; /l ~h.n--. Phone 7c//~/6J>t; vl.
OWNER'SNAMEANDADDRESS'- - - If r./" / J Phon~.J17-1170
Mail report to (ll.APPiicant (f~wner ) Prefer to pick up. Call / (~ner, etc.) when ready.
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STRUCTURES NOW ON THE PROPE~TY -c ......;
rePROPOSED USE OF, ~ROPE~TY{f);'F /J / 0 ( )
WATER SUPPLY ....x.-1er:;<-o<-:::" E MILE OF THE CITY OF, ...A/.;)....?<.-X. ,(NO)
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I hereby certify that the above stateme~ are true and accurate, and that I have the fol wing legal interest in the property: . owner of record;
contract purchaser; potentia)'buyer; realtor or agent. I further Ce ify that (if not the owner) I am authorized "to act for the owner of
record, and that said owner is aware and ap' roves of this action:
TEST HOLES READY --p, .;t-.A ) Signa ~p ~:.aL' ,'1- I'Y/c 0.11.;;..., _
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* .. .. .. * * .. .. * * * .. * * .. * * *~ * .. * * .... * * OFFICE USE ONLY E}ELOW THIS LINE * .. * * .. .. .. * .. .. .. * * * * * * * * .. * .. .. * .. .. ..
Subdivision:
Datp J. ::l.~-l V
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SITE: IZI MEETS STATE STANDARD'S D DO S NOT MEET STATE STAN ARDS. LAND/-l:JSE C0MPLlANCE
,.;;. CiA..4\. / .fiZ/-~ : /.' ~ d ,/.'fh.-- <%-~ ~ Zoning iC-/'-r
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of ~ .L / _ \~' I r /1 r / I -,-,,/7 J1 Acreage or Lot Size J ~I) X (TOTAL)
...a;---r A..t...- ~ L- ~..<f/J. ~ do, 4-~t.. ." ( ) Completed
f Partitioning # ( ) Pending
~ ~. '6<(... ~ .aq,~ r ~- Parcel #
r ~ ~, LAi..f WOroIV S~HnJU PERMIT AR(A
THIS IS A PRELIMINARY REPORT WHICH DOES N T SURE THE ISSUANCE OF A FUTURE BUILDING PERMIT. ANY PLANS OR EXPENDI.
TURES MADE IN RELIANCE UPON THIS REPORT AR AT YOUR OWN RISK. IF SITE IS APPROVED, SEE REVERSE SIDE'-
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AUTHORIZED SIGNATURE
. DiJision of Water Pollution Control
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DATE
6UTHORIZED SIGNATURE DATE
Permit Processing Section ~
125 EAST 8TH AVENUE"EUGENE, OREGON 97401 ~87-4061
LANE COUNTY DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
C55-32
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OAR Chapter 340, Division 7, Section 72-020(6): This report shall remain in effect until issuance of a
permit to construct, unless in the meantime conditions on this or adjacent properties have beEm altered in
any manner which would prohibit issuance of a permit, in which case this evaluation report shall be con.
sidered null and void. Technical rule changes will not invalidate any evaluation report issued pursuant to
this section.
Before construction is started bring this form to the Department of Environmental Management and apply
for a building permit. Exact specifications for the sewage disposal system will appear on the permit.
If the property is only a portion of a tax lot, a partitioning or subdivision must be approved before the
permit will be issued.
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 persons other than the above perform the installation.
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C74-1S0
Vicinity Map
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SITE EVALUATION WORKSHEET
LOCATION: TWP. /9 RANGE .::L SECTION G. L.j TAX LOT # .;;2 6 0 z..
ZONING:
SIZE OF PROPERTY:
PROPOSED USE: '
AMOUNT USABLE AREA: .J!::: ()
PUBLIC 0 INDIVIDUAL 0
WATER SUPPLY: COMMUNITY D
SUBDIVISION/PARTITION
~OT
BLOCK
PARCEL
IF SITE MEETS STANDARDS FILL OUT:
Type of structure and approximate sewage flow:
Multi-family gpd
Commercial gpd
Single Family
Industrial
~
gpd
gpd
gpd
Ins ti tu t iona 1
MINIMUM DESIGN REQUIREMENTS:
Length of disposal trench required
Distribution Method: Equal ~,
Curtain drain required: Yes D
Other:
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Serial D
No ijn
SPECIAL SITE CONSIDERATIONS OR VARIANCE OPTIONS OR OTHER ALTERNATIVES:
NAME:
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DATE OF EVALUATION:
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C74-l26
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-I # 1 T EST H 0 L E # 2 T E S T H 0 L E
/ PERCHED WATER PROFILE PREDICTED WATER PROFILE
Predicted in, Inch Predicted in. Inch
-
Observed in, Observed in.
Date Date
12 - SL 12 -
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SATURATED ZONE SATURATED ZONE
Predicted inl 24- Predicted in 24 -
Observed inl Observed in
Date Date
.36 _ 36 -
Restrictive Layer ~n,
Impervious Layer in,
Mottling in,
SLOPE
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Restrictive Layer )?~
Impervious Layer in
Mottling in
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· SLOPE -.J
60 _
60 -
48
48 -
%
%
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SITE DOES ~ DOES NOT D MEET MINIMUM STANDARDS.
ADMINISTRATIVE RULES REOUIRE ~ MINIMUM DEPTH OF:
0 36 inches to an impermeable layer
0 30 inches to a restrictive layer
0 60 inches to a permanent water table
0 24 inches to a temporarily perched water table
OTHER REASONS FOR DENIAL
PLOT PLAN:
--
Stream
Drainage or
pond
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Road
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Test Hole (8)
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Cut Bank
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Fence
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ON ~ PROPERTY THE DEPTH
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