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Report i t z c s— 54., 7Aa ciz--, V- CleanWater Services , ' . } 4.1 'OF ' lL;itkL► August 12, 2015 `1111 INF T`ISP7. SPL expires on August 11, 2017 TRUMP-HOLLOW BUILDERS 16348 NW CHARLAIS BEAVERTON OR 97006 RE: 572 sq. ft. addition CWS file 15-002135 (Tax map 2S103DC Tax lot 06000) Clean Water Services has received your Sensitive Area Certification for the above referenced site. District staff has reviewed the submitted materials including site conditions and the description of your project. Staff concurs that the above referenced project will not significantly impact the existing Sensitive Areas found near the site. In light of this result, this document will serve as your Service Provider letter as required by Resolution and Order 07-20, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. This letter does NOT eliminate the need to protect Sensitive Areas if they are subsequently identified on your site. If you have any questions, please feel free to call me at (503) 681-3639. Sincerely, (-22'11V7‘-'444-2---- Laurie Harris Environmental Plan Review Attachment(1) 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 Phone: (503)681-3600 • Fax: (503)681-3603 • cleanwaterservices.org • v ,,, .+ #11'154 E ,� C0 112?5 ! N 13- � \ N. I °� cc.^ " a` IV 1123 �` t 11145 � g -- ,fit f. r' t a ,^ 1 F i C3 re-f-a / ' t \ "'"' rn CD Cf C'D i/ i 11235 '` I( !f 1'1'135 l ° ,`��.67 _ 112 �,t ' LA i�5 {7. . [ A. f' fl �Ff ) .. J l',9f . - ‘ 41'/2 �^, a! l 13535 [ 1121 5 e `, v 11305 11245 11225 s _ �`i t,: F fT /N 8 V. a( ,_ , fT © _______, , ....._________ _........i al— 1 } , i { +1 f i H i r 0 Z ,) 11205 1 — L I I '. 1351'45 '` E 1F. 1,. E 310 11234 l } {j 3 p i'} J F Clean Water Services File Number CleanWater Services Sensitive Area Pre-Screening Site Assessment 1. Jurisdiction: 1A a .�-p.? 2. Property Information *temple 1S234AB01400) 3. Owner Information Tax lot I D(s): 2.51(3 >e__ e.pbOca Name: R.�C -14244-N.I.L_Tor, _ Company: _ Address: 101—IV S S 7-,1I P—t-kavCr-o Site Address: 1n-15 61,-) ai ave.rk City, State, Zip: -rta b1-. City, State,Zip. 1 A 941Q-1) Q... Phone/Fax: 31)3 (DI Qj 8 t O� Nearest Cross Street: 419 (.) E-Mail: 4. Development Activity(check all that apply) 5. Applicant Information (21 Addition to Single Family Residence(rooms,deck,garage) Name . — J4OLL DW 4P (...,30 124 ❑ Lot Line Adjustment ❑ Minor Land Partition Company: 12-# �_ p� ❑ Residential Condominium ❑ Commercial Condominium Address: (03( Int 3 C .11g.I S ❑ Residential Subdivision U Commercial Subdivision ❑ Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: i? v��-�r. _ �ppr� Other Phone/Fax: 5-03'631 bs-43 --- --- E-Mail: w+•pt1, U1.00.50'1 6. 08 . "1 6. Will the project involve any off-site work? ❑Yes,'No ❑Unknown I� Location a_nc!description of off-site work 7. Additional comments or information that may be needed to understand your project 2- 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 their matron contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate. Print/Type Name 7 p Print/Type Title t l—tp,��� Signature Date 7 jam, 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 07-20, Section 3.02.1. 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 07-20,Section 3.02.1. 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 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. Reviewed by Date 2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone:(503)681-5100 • Fax:(503)681-4439 • www.cleanwaterservices.org