HomeMy WebLinkAboutMiscellaneous Plumbing 2006-8-23
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"DEO USE ONLY
UNDERGROUND INJECTION CONTROL
REGISTRATION
Residential, Commercial and Industrial Roof Drains
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Oregon Department of Environmental Quality
(see page 2 for detailed instructions)
,
, DEO USE ONLY
Registration #:
Received:
File#:
MaillD #21#9:
DOC Conf,:
OIND' ODOM OUIC:
Notes:
Notes'
" ' , ',.' ' ' ' . 'A.'liJACIUTY NAME; LOCATION & cONtACT .
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1. Legal Name: (-\ G'~ M
It() ""i n e..-
l3{lG
Common Name:
HdQ,(V\
s:r-cta~~
3. Facility Physical Address:
4, Facility Mailing Address:
<:"-
.Jet MC,
City, State, Zip Code: ~)(\ t'1'f1C\O\
CK
City, State, Zip Code:
5. Latitude:
degrees
min,
sec, or decimal:
Longitude:
degrees
min.
sec, or decimal:
6, Facility Contact Name: \=1 ,Je( \ V\ 5-\ ~ JClI\..(, \L-
Contact Telephone #: (;5-;q,.{) 741 - 3 ()*'l1
7. Responsible Official Name: A elet,y'! S-tcd~,,--< ((,
Address: 1)((0 fh.\dL[S ()'v'\ Lrl
-.fldd
I, Land use zoning of facility: 0 Industrial 0 Commercial )8:l Residential 0 Other:
2, Drinking water source:'~ublic water 0 Private Well- Estimate distance to well: feet
3, Estimated depth to winter high water table:
feet
Ifnot available, average depth to groundwater:
reetorunkno~n ~
4. Source of injection water (check one):
~Closed-Loop Roof Drain 0 Parking/Street RunofIiDriveway 0 Landscape Area 0 Other
o InactivelNot in use,
S Active 0 Under Construction
sf 16/0(.,
I I
7, Proposed Injection System Depth: g
ft
Pre.treatment' :
*Required by some municipalities
5, Status:
6, Installation Dale:
8, Number of systems:
(please number on map)
9, List any other DEQ or public agency penn its applied tor or issued to this facility:
10, Attach a map of the sile, indicating adjacent streets, buildings by use, UIes, water features, elC, 0 Attached
To expedite the registration of your facility, please fill out this form in its entirety.
. . "\-. .~, . "- . . ,. .
. " C.SIGNATLIREOI?,LEGALLY AUTHORIZED REPRES~NTATIVE' '. ",:,
.. ,
I hereby certify that the information contained in this registration is true and correct to the best of my knowledge and belief,
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Name of Legally Authorized Representative (Type or Print)
()ti~t~~c/(c'/j;f<l---
- Signature of Legally Aut(orized Representative
Title
8 / ,;)- >/0 fc
,
Date
UICROOF-I 007 (04i04)
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NOTE: BEARINGS AND DISTANCES DEPICTED
HEREON BASED ON A BOUNDARY RESOLUTiON
BY THIS FIRM TO BE SHOWN ON A FUTURE
SURVEY MAP TO BE FILED WITH THE LANE
COUNTY SURVEYOR'S OFFICE,
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TENT A TIVE PARTITION PLAN
FOR
ADAM STEFANEK
ASSESSOR'S MAP 17 -03-28-40 TAX LOT 2808
SPRINGFrELD. Lf,NE COUNTY, OREGON
JUNE 7, 2005
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6ENERAL- NOTE~
SITE ASSESSMENT OF EXISTlN6 CONOITIOf
THERE ARE NO VIA TER COURSES ON THE SUBJECT PROPERTY,
THE SUBJECT PROPERTY IS NOT LOCA TED WITHIN THE 100-YEM FLOODP!
THE SUBJECT PROPERTY IS LOCATED BEYOND THE 99 YEM TIME OF TR,
PER THE DESIGNA TED WELLHEM PROTECTION AREA IMP.
CONTOURS AS BASED ON CITY OF SPRINGFIELD BENCHMARK .JSS
ISOUARE TFC 1/2 CR NW COR ISLAND 5' w, & 7' 'I OF OM TREE) . ELEV,
THE SITE IS PRIMARIL Y MDE UP OF MAUBON-URBAN LAND' COMPLEX 5011
TENTA TIVE PARTITION PLAN
THE SUBJECT PROPERTY COMPliES WITH THE SOLAR DESIGN ST ANDARDS
PER SDC J4,01013Hb1llHa) IN THAT BOTH PARCELS EXCEED NORTH.SOUTH
OF 90 FEET AND SOC J4,Ol0lJHbH2Hcl IN THAT THERE IS A T LEAST 70
8ETWEEN THE SOLAR,BUILDING LINE ON THE LOT TO THE NORTH AND TH
MIDDLE OF THE NORTH.SOUTH DIMENSION OF THE LOT TO THE SOUTH, ME
ALONG A LINE PERPENDICULAR TO THE SOLAR BUILDING liNE,
NO PLANTlNGS OR STREET TREES ,~RE PROPOSED AS A PART OF THIS
PARTITION,
TRANSIT FACILITIES ARE LOCATED ON CENTENNIAL BLVD, ADJACENT TO
SUBJECT PROPERTY,
NOTE: PROPOSED PARCEL OIMENSIONS PRECLUDE ANY REDEVELOPMENT OF
SUBJECT PROPERTY,
6RAOIN6, FA VIN6 ANO STORMWA TER MANA
STORM DRAINAGE WILL BE DIRECTED TOWARD THE EXISTING PUBLIC STORI
DRAINAGE SYSTEM LOCATED ALONG THE WEST MARGIN OF ANDERSON LAI
NO NEW PUBliC STORMWA TER FACiliTIES SYSTEMS ARE PROPOSED AS A
PART OF THE DIVISION OF THE SUBJECT PROPERTY,
NO SITE EXCAVATION OR FILL ACTIVITIES ARE PROPOSED AS A PART OF
DIVISION OF THE SUBJECT PROPERTY,
TRANSPORTATION
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AOEOUA TE ON'SITE PARKING WILL BE ,WAIL^,BLE*ITHIN GARAGES OR *11
DRIVEW.\ Y AREA EACH PARCEL.
o THE APPliCANT IS REOUESTlNG THA T THE CITY FORGO THE REOUlREMENT
ci A fRA,FFIC IMPACT STUOY BECAUSE OF THE NEED FOR ONL Y ONE ADDITI
'" --- DRIVEWA Y ACCESS,
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A VENUE
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REGISTERED
PROFESSIONAL
LAND SURVEYOR
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OREGON J
.JJIIrE :;0.1091
LLOYD L, TOLBERT
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iDIWIIl .AN: 3Q. _ \
LEI
ENGINEERING
DIVISION OF LOGGING ENGINEERING INTERNA
1243 WEST 7TH AVENUE
EUGENE. OREGON 97402
(541) 683-8363 FAX (541) 663-6144
WWW.LEIINC.CO... OWN ~:r': _LL.! _