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Rec¢ivcet l~y: ' _ ~(.. __ COMMUNITY DEVELOPMENT CENTER 285 Church St. NE - Room 132 [Zoning Validation: ~S Salem, Oregon 97301 ~ 24hr. Inspection Line 588-7904 FEB - 9 1996 8:00am~:30pmPhone58~S,47 __ SITE EVALUATION AND/OR SEPTIC PE~IT APPL~CAT[~iLDiNG INSPE~ION 1. LOCATION OF INST~LATION Alvin & Barbara Santos SobAdd~ss 200 M~y~r .~t. - Detrnit: IMailing Address 54-127 Kealalani Pl. HI Ph°neN°'(808) 293-9999 OR - q7_':l&? [TaxAcct. No. 66964-001 Cross Street Iake m~ ffb~ Use of Stmcture recreational Lot tes & ds No. Employees ~, / Existing No.Proposed No. Bedrooms 2 B~clrooms Sec.on 1 Tow hip 10S nge rE [Zone I Map WaterSupp,y: Private Well( ) Spring ( ) LotWidth 80 ' LotDepth ~(~ ! Acres _ '[ 4 [ Irreg. Lot yo_s / Comer yeg Community Well ( ) City (X) 2. CONTRACTOR INFORMATION Subdivision ~r°pe"yOw"er Alvin & Barbara Santos MailingAdmcss54-127 Kealalan' PhoneNo. (808~ 293-9999 Auth. Agent/Leasee Robin Church - Homestead West R.E. Mailing Address P.O. Box 379 PhoncNo. 897-2357 Conlmctor Business Name & Number Mailing Address Phone No. 769- 2302 3. FEES ** Fees include DEQ Sumharge ($30.00) $ Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 Site Evaluation, Single Family Dwelling, ea addl lot ...................................................................................................... 235.00 Site Evaluation, Commercial, fa-st 1000 gallons ............................................................................................................. 320.00 Site Evaluation, Commercial 1000 - 5000 gallons .................................................................................... 320.00 + $90/500/gal + $100/500 gallons Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 Construction Permit or Commercial Major Repair, first 1000 gallons: Standard System ................................................................................................................................. 382.00 Aerobic System .................................................................................................................................. 218.00 Capping Fill System ........................................................................................................................... 593.00 Cesspool ............................................................................................................................................. 382.00 Disposal Trench in Saprolite .............................................................................................................. 382.00 Evapotranspiration-Absorption System ............................................................................................. 218.00 Gray Water Disposal Sump ............................................................................................................... 190.00 Pressure Distribution System ............................................................................................................. 553.00 Redundant System ............................................................................................................................. 382.00 Sand Filter System ............................................................................................................................. 703.00 Seepage Pit ......................................................................................................................................... 312.00 Seepage Trench .................................................................................................................................. 382.00 Steep Slope ......................................................................................................................................... 382.00 Tile Dewatering System ..................................................................................................................... 550.00 Construction Permit or Commercial Major Repair, over 1000 gallons: Construction Permit Fee + $25/500 gallons Commercial Plan Review 600 gallons - 1000 gallons ............................................................................................................... 133.00 1000 gallons - 2500 gallons ............................................................................................................... 133.00 + $25/500 gallons Commercial Minor Repair ............................................................................................................................................... 173.00 Single Family Dwelling, Minor Repair (tank only) ................................................................................................... ..~,A30.00 Single Family Dwelling, Major Repair (drainfield) ............................................................................................... .~...~.~-/ Residential or Commercial: Alterations .......................................................................................................................................... 378.00 Permit Renewal, Field Visit ............................................................................................................... 227.00 Permit Renewal, No Field Visit ......................................................................................................... 115.00 Authorization, Field Visit .................................................................................................................. 247.00 Authorization, No Field Visit ............................................................................................................ 117.00 Existing System Evaluation ............................................................................................................... 247.00 Annual Evaluation/Alternative System .............................................................................................. 247.00 Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183.00 Annual Evaluation, Large System ..................................................................................................... 123.00 Pump or Dosing Siphon ....................................................................................................................... 25.00 Pumper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 Pumper Truck Inspection, Ea Additional Vehicle ............................................................................................................. 40.00 Septic Reinspection Fee ..................................................................................................................................................... 25.00 Septic Inspection for which no fee is specifically indicated .............................................................................................. 40.00/hr Name of Applicant (Please Print): Test Holes Ready: Signature of Applicant: Date: Tank Pumped: Date MC 15-SI Rev B/95 Pumping Certification Attached: (Y)