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STATE OF OREGON DEPARTMENT OF ENVIRONMENTAL QUALITY For Office k)~e Only REPORT OF EVALUATION FOR ONE LOT ON-SITE SEWAGE SYSTEMS The Entire Property .~ Has Been Evaluated PLOT PLAN OF APPROVABLE AREA: I/qxlzo Any alteration of the natural conditions in the area approved for the on-site system or replacement area may void this approval. 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 Administrative Rules of the Environmental Quality Commission. Any such subdivision, partitioning or alteration may void this report. "['he site has beej~ found suitable for installation of the following kinds of on-site sewage disposal systems, with the limitations~~.~~~__.an dit' al equi outs indicated: _,~ ~~- , WARNING: This document is a technical report for on-site sewage disposal only. It may be converted to a permit only if, at the time of application, the parcel has been found to be compatible with applicable LCDC- acknowledged local comprehensive land use plans and implementing measures or the Statewide Planning Goals. The Statement of Compatibility may be made on the attached form or it:s equivalent. Authorized Agent approval is required before a construction permit can be issued. ~ rep~c is ~alidr~r~ti], an ~on-slte sewage system is installed pursuant to a construction permit obtained from ~ .--(~-.z.~ ~.._, or until earlier cancellation, pursuant to Commission rules, with written notice thereof by the Department ~)f Envffonmental Quality to the owners according to Department records or the County tax re, cords./4~j~ to t~e )~F~going~this report runs with the land and will automatically benefit subsequent owners.