HomeMy WebLinkAboutMiscellaneous Sewer Connection Record 1991-11-22
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SEjY.AGE DISPOSAL SITE EVALUATION
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~IO ill'Wr\'tt~ . ection~ (7; u-T c,t7"t;]'c, ';)..k/ ~ f)d,,/,';'r- ~,.LYyt, l.e-f-r enC!" 0
SUbdivision:1{Ji//qM,f,T(f> 1:Ie!f/t;0. D/?-f.-Yl<; C.100}-j ,':;(sT;,v~ 01-1 lo-f----r ~ \(1,1
L'" \ \ Block I -:L WATER SUPPLY vI ~l \ .Cl ~
APPLICANT'S NAME AND ADDRESS \ /i:v;J 1/ \" 1Y i <'> y' l"ijnO' 'V) )'D"<VI. IT ';.pJrli:}-f" t P- ) r/J CtI'Z-.:Phone / \ Lf 7.-/0 (;
OWNER'S NAME AND ADDRESS !;.;-~ ':.:., ':!..PhonI'5--fi.n? er
STRUCTURES NOW ON THE PROPERTY '/L /Y....,~ . .-T PROPOSED USE OF PROPERTY
- - --....j,
I hereby certify that the above statements are true and accurate. and that I have the following legal interest in the property: _ow~er of ecord; _~t purchaser; ---potential buyer;
~realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of record, and that said owner is swam an pr e 0 ~ apion.
.T HOLES READY ~ r. ALI4/ Signatu@ /;. Oat"
........ '" '" '" "'.. "'.... "'.. "'........ "'...... "'............................... "'..",... "'.. "'.. '" '" OFFICE USE ONLY BELOW THIS LINE ........................... ..I.........
../............. ................................. ....
,
SITE MEETS STATE STANDARDS YES NO YES NO
Standard System 0 0 Low Pressure Distribution 0 0
Sand Filter ~ 0 Holding Tank 0 0
1 Foot Capping Fill 0 0 Other 0 0
Zoning
LAND USE COMPLIANCE
Acreage or Lot Size
(lOTAL)
Partitioning # Parcell! { l Completed
( Pe~d~g
COMMENTS:1) ~l> SI"o)h~Il?/Cf
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FLOODPLAIN ..NFORMATION
o Approximate
Study Area
o Detailed
Study Area
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 RISK. IF SITE IS APPROVED, SEE REVERSE SIDE.
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-- \W:ffiORIZED'Gl6NAf~'=
LANE COUNTY ENVIRONMENT~HEALTH, 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (6&7-4051)
C55-32
o Floodway
//~? Z- -"[I
DATE
All or part of this site may be in a flood hazard
area for which 100 year flood levels have not
been established. Extra precautions may be
appropriate to assure that the building site will
be reasonably safe from flooding.
All or part of this site may be in a flood hazard
area for which 100 year flood levels have been
established. A building elevation above the 100
year flood level may be required.
AU or part of this site may be in a flood hazard
area in which 8 floodway has been designated.
Building may be prohibited subject to
demonstration that the cumulative effect of
proposed development will not increase the
100 year flood level at any point.
.
MEMO
TO: APPLICANT
FROM: LANE COUNTY ENVIRONMENTAL HEALTH
SUBJECT: CONDITIONS OF SITE APPROVAL
lane county
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Any alteration of the natural conditions in the area approved for the on-site system or replacement area may void this approval.
This approval is given on the basis that the lot or parcel described above will not be further partitioned or subdivided and that conditions
on subject or adjacent properties have not been altered 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.
WARNING: This document is a technical report for on-site sewage disposal only. It may be converted to a permit only if, at the time of
application, the parcel has been found to be compatible with applicable LCDC-acknowledged local comprehensive land
use plans and implementing measures or the Statewide Planning Goals. The Statement of Compatibility may be made on
the attached form or its equivalent. Authorized Agent approval is required before a construction permit can be issued.
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 Environmental 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.
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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Tax Reference
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SITE EV AWAno:: FIELD \iOHKSP.EET
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W.ater Supply: Well COllmUflity PUbl ie
Appl1cant
lOf'l1ng:
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Parcel Size:
Depth
Text:~e
Soil Macrix Color and MOttling (Notation). 'Coarse F=agments. Hoots,
Struc~~e. Layer Limiting Effective Soil Depth. etc.
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Special Conditions
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A pcr::-'I is required
prior to st,-c LoCg construction.
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Environmental Health ~1ces
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. W: 3 LANE COUNTY DEPT ENV MGT RECEIPT ~ 910331 DATE 11209_
APPLICANT TAYLOR, VIRGIL ADDR 1960 N. 18TH ST., SPRI~GFIELD. OREGO~
IGlrrL~ 1803022000100 SUBDIV 1700 LOT BLK J",
.NEW BLDG,TYPE USE X BDRMS 0 UNITS 001 STORIES ~BLDGS 001 PHONE 747 109El
OWNER NME TAYLOR, VIRGIL ADDR 1960 N. 18TH ST., SPF(INGFIELD, OREG9'
CODE APPL NO ACTION DESCRIPTION SQ FT UNIT COST VALUATION FEE DA"S I".
BP 1
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SDEQ FEE, SI
SWR: FT. WTR:
MECHANICAL FEE
STATE SURCHARGE
PLAN CHECK FEE
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FT. RAIN:
FT
160.00
160.00
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EST. COMPLETION DATE
DEPOSIT **
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