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CleanWater Services Service Provider Letter
Our commitment is clear.
Submission Date: Jan 09, 2020 Confirmation#: 334
Applicant Name: KM CONSULTING SERVICES CWS File#: 20-000069
Contact Email: alexis.kmconsulting@gmail.com Review Type: Partner City Plan Review
Contact Phone: (503)407-6559 Ground Disturbance: 75
Primary Address: 10135 SW Hillview ST New Impervious Area: 0 RECEIVED
ED
Tigard,OR 97223 JAN 1 3 2020
Primary Jurisdiction: Tigard Mod. Impervious Area: 0
CITY OF TIGARD
Affected Tax Lots: 2S102CCO2200 Development Activity: SFR AdditioAUILDING DIVISION
Project Description: replacing 390 sf wooden deck with like style composite deck; ;Sfd Addition
FOR DISTRICT USE ONLY
N 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 qualitysensitiveareas ifthey 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 asyourService 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 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.
❑ NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed By: LDRToolReview Date:January 9, 2020
The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the Tualatin
River Watershed.Our partners include municipalities,environmental organizations,and developers large and small.
Contact Us*2550 SW Hillsboro Highway*Hillsboro,Oregon 97123
phone:503-681-5100*email:splreview@cleanwaterservices.org*website:www.cleanwaterservices.org/permits-development
Clean Water Services-Service Provider Letter
Submission Date: 1/9/2020 Confirmation#: 334
Applicant Name: Alexis Michaud Review Type: Partner City Plan Review
Contact Email: alexis.kmconsulting@gmail.com Ground Disturbance: 75 Sq. Ft.
Contact Phone: 503-407-6559 New Impervious Area: 0 Sq. Ft.
Primary Address: 10135 SW HILLVIEW ST Mod.Impervious Area: 0 Sq. Ft.
Primary Jurisdiction: Tigard Development Activity: Single-Family Dwelling Addition
Affected Tax Lots: 2S102CCO2200
INSTRUCTIONS:This pre-screening report is the Service Provider Letter(SPL)as required by Resolution and Order 19-5,Section
3.02.1,as amended by Resolution and Order 19-22.PROVIDE A COPY OF THIS SPL TO THE JURISDICTION RESPONSIBLE FOR LAND
USE REVIEW AND PERMIT ISSUANCE.This pre-screening review does NOT eliminate the need to evaluate and protect water quality
sensitive areas if they are subsequently discovered and this review does NOT eliminate the need to obtain additional CWS permits
or reviews if project changes in scope or location.All required permits and approvals must be obtained and completed under
applicable local,State and federal law.
Permit or Review Required Next Steps
Environmental Site Assessment No
Review
Water Quality Treatment Review and TBD Contact city(primary jurisdiction)responsible for land use review and permit
Stormwater Inspection issuance.
Erosion Control Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit
issuance.
Erosion Control Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit
with Site Plan issuance.
Line Tap Inspection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit
issuance.
Disconnection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit
issuance.
Connection Permit TBD Contact city(primary jurisdiction)responsible for land use review and permit
issuance.
Connection Permit with Plumbing TBD Contact city(primary jurisdiction)responsible for land use review and permit
Plan issuance.
Easement Review TBD Contact city(primary jurisdiction)responsible for land use review and permit
issuance.
The CWS Development Services group is here to review your project in the most effective and efficient way,while protecting the Tualatin River Watershed.Our
partners Include municipalities,environmental organizations,and developers large and small.
Contact Us*2550 SW Hillsboro Highway*Hillsboro,Oregon 97123
phone:503-681-5100*email:splreview@cleanwaterservices.org*website:www.cleanwaterservices.org/permits development
P ,
Clean Water Services File Number
C1eanWate�� Services
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: City of Tigard
2. Property Information (example 1S234A801400) 3. Owner Information
Tax lot ID(s): 2S102CCO2200 Name: Steve Foltz
Company:
Address: 10135 SW Hillview St
0R Site Address: 10135 SW Hillview St City,State,Zip: Tigard,OR 97223
City, State,Zip: Tigard, OR 97223 Phone/Fax:
Nearest Cross Street: SW Hillview& SW 100th Ave E-Mail:
4. Development Activity(check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence(rooms.deck,garage) Name: Alexis Michaud
❑ Lot Line Adjustment ❑ Minor Land Partition Company: KM Consulting Services
❑ Residential Condominium ❑ Commercial Condominium 10875 SW Avocet Ct
Address:
[] Residential Subdivision Cl Commercial Subdivision
laSingle Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Beaverton, OR 97007
Other Phone/Fax: 503-407-6559
E-Mail: alexis.kmconsulting@gmail.com
6. Will the project involve any off-site work? ❑Yes Q No ❑Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
New deck to replace exisiting , 9 U
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 Alexis Michaud Print/Type Title Owner-KM Consulting Sercvices
Signature a€1 Date 12/31/19
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 19-05, 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 19-05,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.
U This Service Provider Letter is not valid unless CWS approved site plan(s)are attached.
Li 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
Once complete, email to: SPLReview@cleanwaterservices.org • Fax: (503) 681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Revised 6/2017
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