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Correspondence RECEIVED Av- 2,0 - =s JUL 10 2020 �� CITY TIGARD CleanWater`Services SENSITIVE AREA PRE-SCREENING SITE ASSIESSMENTIN Clean Water Services File Number 20-001706 1. Jurisdiction: Tigard 2. Property Information(example: 15234AB01400) 3. Owner Information Tax lot ID(s): Name: Chris and Jennifer Nguyen 2S110CB09000 Company: Address. 12412 SW Autumn View St OR Site Address: 12412 SW Autumn View St City, State, Zip: Tigard,OR, 97224 City, State,Zip: Tigard, OR, 97224 Phone/fax: 5033519381 Nearest cross street: sw st andrews In Email: chrisnguyen020407@gmail.com 4. Development Activity(check all that apply) 4. Applicant Information © Addition to single family residence(rooms, deck, garage) Name: Chris Boyle ❑ Lot line adjustment 0 Minor land partition Company: Dick's Evergreen Fence and Deck ❑ Residential condominium 0 Commercial condominium Address: 4815 SE Tualatin Valley Hwy ❑ Residential subdivision ❑ Commercial subdivision City, State,Zip: Hillsboro, Oregon, 97123 ❑ Single lot commercial 0 Multi lot commercial Phone/fax: 5033135325 Other Email: dicksevergreen@gmail.com 6. Will the project involve any off-site work? ID Yes 0 No 0 Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: installing new backyard deck next to existing deck This application does NOT replace Grading and Erosion Control Permits,Connection Permits, Building Permits,Site Development Permits, DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true, complete, and accurate. Print/type name Chris Boyle Print/type title Vice President Signature ONLINE SUBMITTAL Date 6/22/2020 FOR DISTRICT USE ONLY ❑ Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. ❑ Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200' of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1, as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local, State and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site. This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local, state and federal law. THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS 1 CWS APPROVED SITE PLAN(S)ARE ATTACHED. The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. SEE MOUNTAIN VIEW ESTATES PLAT Reviewed by e.. t._. Date 7/10/2020 Once complete,email to:SPLReviewecleanwaterservices.org • Fax: (503)681-4439 OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway, Hillsboro, Oregon 97123 a .a•_ 2ozo Main Office • 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cleanwaterservice>.org DICK'S EVERGREEN FENCE & DECK INC. CCB#108350 N u ery O L 12`(1 L. s J 4,41,4%An Y'ra .cf 4815 S.E.T.V. HWY. • HILLSBORO,OREGON 97123 JOB 3 Y (503) 640-7700 • FAX (503) 640-0466 SNEET NO. OF r.boyle@comcast.net Xi: www.dicksevergreen.com SCALE • APPROVED By Chuck Buckaflew for Clean Water Setvk es at 5:44 am,Jul?0,2020 lltit 24� i 8 1 311 (kfwr