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~Y USE ONLY <br /> <br /> IOat¢; 1% <br /> SITE EVALUATION <br /> 1. LOCATION OF INSTALLATION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St. NE - Room 132 <br /> Salem, Orngon 97301 <br /> 8:00am-4:3Opm Phone $88-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> <br />COUNTy <br />IN$P~CTIoN <br /> <br />2. CONTRACTOR INFORMATION <br /> <br />C°n~cmr Business N~e & Num~ ~a~ <br /> <br />Mailing Address <br /> <br />Mailing Address <br /> <br />Phone <br /> <br />:3. FEES <br /> <br />** F~cs include DEQ Surcharge ($30.00) <br />Site Evaluation, Single Family Dwelling, first lot ......................................................................................................... $320.00 <br />Site Evaluation Single Family Dwelling, ea add ot ....................... 235 00 <br />Site Evaluation, Commercial, first 1000 gallons ............................................................................................................. 320,00 <br />Site Evaluation, Commercial 10~0 - 5000 gallons .................................................................................... 320.00 + $90/500/gal <br />Site Evaluation, Rural Area Variance .............................................................................................................................. 320.00 <br />Construction Permit or Commercial Major Repair, first 1000 gallons: <br /> Standard System ................................................................................................................................. 382.00 <br /> Aerobic System .................................................................................................................................. 218,00 <br /> Capping Fill System ........................................................................................................................... 593.00 <br /> Cesspool ............................................................................................................................................. 382.00 <br /> Disposal Trench in Saprolile .............................................................................................................. 382.00 <br /> Evapotransplration-Absorpfion System ............................................................................................. 218.00 <br /> Gray Water Disposal Sump ............................................................................................................... 190.00 <br /> Pressure Distribution System ............................................................................................................. 550.00 <br /> Redundant System ............................................................................................................................. 382.00 <br /> Sand Filter System ............................................................................................................................. 703.09 <br /> <br /> Steep Slope ......................................................................................................................................... 382.00 <br /> Tile Dewatering System ..................................................................................................................... 550.00 <br /> Construction Permit or Conunercial Major Repair, over 1000 gallons: <br /> Construction Punnit Fee <br />~ Commercial Plan Review <br /> 600 gallons - 1000 gallons ............................................................................................................... 133.00 <br /> ,; 1000 gallons - 2500 gallons ............................................................................................................... 133,00 <br /> , Commercial Minor Repair ............................................................................................................................................... 173,00 <br /> Single Family Dwelling, Minor Repair (tank only) ......................................................................................................... 130.00 <br /> Single Family Dwelling, Major Repair (dralnfiald) ........................................................................................................ 210.00 <br /> Residential or Conanercial: <br /> Alterations .......................................................................................................................................... 378.00 <br /> Permit Renewal, Field Visit ............................................................................................................... 227.(30 <br /> Permit Renewal, No Field Visit ......................................................................................................... 115.00 <br /> Authorization, Field Visit .................................................................................................................. 247.00 <br /> Authorization, No Field Visit ............................................................................................................ 117.00 <br /> Existing System Evaluation ............................................................................................................... 247.00 <br /> Annual Evaluafion/Altematlve System .............................................................................................. 247.00 <br /> Annual Evaluation Temporary/Hardship Mobile Home .................................................................... 183,00 <br /> Annual Evaluation, Large System ..................................................................................................... 123.00 <br /> Pump or Dosing Siphon ....................................................................................................................... 25.00 <br /> Pumper Truck Inspection, First Vehicle ............................................................................................................................ 67.00 <br /> Pumper Truck Inspection, Ea Addifioual Vehicle ............................................................................................................. 40.00 <br /> Septic Reinspection Fee .................................................................................................................................................... 25.00 <br /> Septic Inspection for which no fee is specifically indicated ............................................................................................. 40.00/hr <br /> <br />ameof Apphcant(PlcaseP~ ,~/',L ,O s0OA/A/~__~L._ <br /> <br /> $ <br /> <br />+ $100/500 gallons <br /> <br />+ $251500 gallons <br /> <br />+ $251500 gallons <br /> <br />Test Holes Ready: <br /> Dale <br />Tank Pumped: <br /> <br />Pumping Certification Attached: (Y) (N) <br /> <br /> <br />