HomeMy WebLinkAboutSpecial Inspection Septic Tank 1995-10-5
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SEWAGE DISPOSAL SITE EVALUATION
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X TRS, TL '~/V1/fP /10.3 -1'-1- 3-3 Job Location /~ 27 A 1'Jd e rsC'Vl L IA Spf-ld"" OR ,97t.J.'17
-rA'X I Lor 13~OO Written Directions ^,Or"lh 0\.-\ .Ll~..o"'~o'lA L....... ;')-ff' r"_ ",,+Pl-\I-'\ICi ~ '
Subdivision: /V ~ }
Lot ,/' Block -------- WATER SUPPLY Yo.. ; "V1 ho I.{/ U .bfev- '
APPLlCANT'SNAMEANDADDRESS. ~h n C 4yuj@Y'Sn?". /4'27 A",dei'<::..n"JA U ~ Phone~-/S-YZ
OWNER'SNAMEANDADDRESS ;bAn <2.. Dl'lc'(E'! C'. 4yejpa",~Vl . I ,I' 1-1 I J Phone~7L~ .1~
STRUCTURES NOW ON THE PROPERTY. 4 PROPOSED USE OF PROPERTY' 5.:....!-;! ..1-.;, . . ". / /~ h
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I hereby certify that the above statements are true and accurate, and that I have the following legal interest in th roperty'- "lwner of record; contract purchaser; "lotential buyer;
realtor or agent. I further certify that (if not the owner) I am authorized to act for the owner of record, an t ,t said w!'er is~re a~prov'p of ~h~ :.sttiJry'
.ST HOLES READY .... -::s ~ Signature M1.. V ~ Y-- Dat..
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X * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * OFFICE USE ONLY BEL W THIS LINE * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
THIS REPORT IS NOT A PERMIT FOR S~AGE SYSTEM INSTAllATION
The area des~r~b~d on~~e~,~~~lot Pla~ dat~ I~, <~1q>- is . APPt?(}OG~ for a
L ~.l j-" fJ/f!~ (~r-: ~ ~,.~e L _6K.L- syste~
ADDITIONAff~MENT~~Jf~/'~~~5'-' (C/i P/24rI()H~
St:;' . ( - Ih l-f5"-5 -3 I 0 {\J Cr7vUTb-R::
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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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 I~PPR9VED, SEE REVERSE SIDE.
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~ DEQ AUTHORIZED AGENT
IQ'/SZ;~ _
... DATt
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
* -*
* 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. *
* ~*
* ** * * * * * * * * * * *' * * * * * * * * * * * * * * * * * * * * * * * * *
LANE COUNTY ENVIRONMENTAL HEALT~. 125 EAST 8TH AVENUE, EUGENE, OREGON 97401 (687-4051)
C55-32
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MEMO
TO: APPLICANT
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.
2. 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 Adm!nistrative Rules of the Environmental
Quality Commission. Any such subdivision, partitioning or alteration may void this report.
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 accordir:lg 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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A permit is red ' f- -- - -- - - .... t ,.l --l
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SITE EVALUATION FIELD WORKSHEET
/ 7-03-, -:>7- 3- ':2 .- /3100
Tax Reference ~./ Rvaluator
Applicant Prvvgtl.~5a(./Date Iff/It{ /9\ ~:~v./
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Zoning
Use
Parcel Size
Water supply: Well COllllllllity Public
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Soil Matrix Color and Mottling (Notation). %Coarse Fragments, Roots,
Depth Texture Structure, Layer Limiting Ef~ective Soil Depth, etc.
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Special Conditions
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W: 3 -,' :...t.INE COUNTY IH::v.'T "ENV MGT F~ECEIPT :jj: 950304 DATE 10039
, APPLICANT ANDERSON. JOHN ADDR 1427 ANDERSON LN.. SPRINGFIELD, ORE
--~rUl: 170'3273313400 -SUBDltf"-.----------- --'-------l~OT--- BU<--,-'
NEW BLDG TYPE USE X BDRMS 0 UNITS 001 STORIES IBLDGS 001 PHO~E 726 1592
m,JNEF~ NME' ANDEF~SON. JOHN A,DDF: 'j 427 f'\NDERSDN LN., spr~ I NGF I EU> I or':E-",
conE APF'L NO ACTION DESCF~IPTION 'SQ FT UNIT COST VALUATION FEE DA'YS
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