Alfalfa Farm 25840 Alfalfa Market Road Bend, OR
Farm & Ranch D I V I SIO N
650 SW Bond St, Ste 100 Bend OR 97702
PAM MAYO-PHILLIPS & BROOK HAVENS PRINCIPAL BROKERS 541.480.1513 | 541.604.0788 pam.mayo-phillips@sothebysrealty.com brook.havens@sothebysrealty.com www.desertvalleygroup.com
All Brokers are licensed in the Sate of Oregon. Each office is independently owned & operated. All information is deemed reliable, but not guaranteed by Cascade Sotheby’s International Realty. Purchaser shall have sole responsibility to inspect the property and inform themselves of the true condition thereof. Purchaser accepts the responsibility before submitting any offer or executing contract. Any grazing permits /leases/water rights are NOT Guaranteed by Seller or Cascade Sotheby’s International Realty, Buyer is responsible for due diligence.
Alfalfa Market Farm Address: 25840, 25850 & 25620 Alfalfa Market Road Bend Oregon 97701 Tax Map: Consolidation of Tax lots and Boundary Lines: Tax Lot 1301/1302 - 39.59 acres with 27.03 acres water rights . Tax lot 1300: 39.45 acres with 37 acres water rights. Original Home on Tax Lot 1301 is not a legal dwelling, can be used as an office. Buyer is responsible for due diligence. Manufactured Home home on Tax lot 1302 is legal dwelling, can be replaced, shares well with Tax Lot 1300/1301. Property: • 79.04 acres • 64.03 acres COID water rights – Irrigated with wheel lines and handlines currently planed in orchard grass. • Deed Restriction for Marijuana operations recorded with Deschutes County Improvements: • 1440 sf Log Home built in 1995 1 bedroom, 1 bathroom with loft • 892 sf original home (bunkhouse/studio) with loft – not a legal dwelling Sold As-IS This structure does have water damage from water heater leak. • Office with bathroom 480 sf (manufactured) near hay barn • 2760 sf Hay Barn • Barn • Shop • Single wide manufactured home (replacement dwelling) on Tax Lot 1302 Irrigation: COID 64.03 acres of water rights 2019 Assessment $1850. Domestic Water: All homes currently on property serviced by well near shop. New well on property at log home is not connected to system. Utilities: Central Electric Coop 12 month averages 25840 Alfalfa Mkt House $147. Irrigation $475. 25620 Alfalfa Mkt House: $123./month $85./month during season Taxes: 2018 Tax Year $3373.98 Property is in farm tax deferral, Buyer is responsible for due diligence and maintaining after the close of escrow. Zoning: EFU Exclusive Farm Use Price:
$995,000.
MLS 201908714
Shown By Appointment Only All information Provided by Cascade Sotheby’s International Realty and Agents is deemed reliable but not guaranteed, Buyer is responsible for any/all due diligence. | 541-923-1376 | www.desertvalleygroup.com
DODDS RD
ALFALFA MARKET RD
01301
Tye Properties tab-h.mxd
This map was derived from data provided by Deschutes County. AmeriTitle has provided this information as a courtesy and assumes no liability for errors, omissions, or positional accuracy in the data, and does not warranty the fitness of this product for any particular purpose.
Disclaimer
Tye Properties Proposed Lot Line Adjustment
Lot line adjustment boundary shown on this map is an approximation, and should be used for general reference only.
EL K LN
ALFALFA MARKET RD
Proposed Lot Line Adjustment
Existing Property Line
01302
[
0
250
Feet
01300
500
MAP DATE: 8/23/2019
www.amerititle.com Copyright Š 2019 by AmeriTitle. All Rights Reserved. Printed in the USA
ALFALFA MARKET RD
171422 SESW 01300 171422 SWSW 01300 171422 SWSW 01301 171422 SWSW 01302
H-15-11
±
0.59 ac 0.39 ac 0.01 ac 0.23 ac
0.04 ac
H-15-8
0.09 ac
0.5 ac
0.17 ac
1.06 ac
H
-15
0.13 ac 0.2 ac 0.02 ac
ABANDON
Legend TAXLOTS PAST 5 CANALS ACRE-TEXT
0
220
440
Feet 880
Image: 2018
171422 SESW 01300 171422 SWSW 01300 171422 SWSW 01301 171422 SWSW 01302
H-15-8
H-15-11
±
H-
15
ABANDON
Legend TAXLOTS CANALS ACRE-TEXT
0
220
440
Feet 880
Image: 2018
DESC 61134
Page I of3
W EL L 1.0. LABEL# L 129277 ST ART CA RD # "°"1_0_3-8 1_0_3- - - - - - - - - - 1
STATE OF OREGO N WATER SU PPLY WELL RE PORT
4/10/2018
(a s required by ORS 537.765 & OAR 690-205-0210)
I
ORIG INA L LOG#
( 1) LAND OWNER
Owner Well 1. D. _ _ _ _ _ _ _ _ _ __, First Name BILL Last Name TYE Company _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
----------
----------
Address 25840 ALF ALFA MARKET RD City BEND State
OR
Sec
Zip 9770 I
(2) TYPE OF WORK
D
[8]New Well D Deepening Convers ion Alterat ion (complete 2a & I 0) Aba ndonment( complete Sa)
0
0
(2a) PRE-ALTERATION Dia + Cas in g : c = J Material Sea l:
From
To
Gauge
From
I
Stl
I
Piste Wld Thrd
I() CJ D D
To
Amt
sacks/lbs
I
I
I
O industri al/Comm ericial 0
Livestock Ooewatering Other
(5) BORE HOLE CONSTRUCTION
Date !Ex isting Well I Pre-Alteration I Well I 3/21 /20 18 Flowing Artesian? 0
0 (Attac h copy)
I
SEAL sacks/ From To Amt lbs 42 .5 41 s 0 Ca lcu lated 24 . 1
I
De
How was seal placed: Method DA DB E Do [gjother BENTON ITE DRY Backfill placed from _ _ _ ft to _ _ _ ft Material _ _ _ _ _ __
Amoun t
(Sa) ABANDONMENT USI NG UN HYDRATED BENTONITE Actual Amount
Proposed Am ount
(6) CASI NG/LINER Stl
Shoe
0
Inside [8)0utside
Temp casinGYes Dia
0
Other
From
Pi ste Wld Thrd
Location of shoe(s) _7_9_5_ _
+O
I
1
To
(7) PERFORATIONS/SCREENS Perforations Method _F_a_ct_o-"ry_C_,_1t_ _ _ _ _ _ _ _ __ Screens Ty p e _ _ _ _ _ _ _ Material _ _ _ _ _ __ #of Tele/ Scrn/slot Slot Perf/ Casing/ Screen slots pipe size Screen Liner Dia From To width leno th Perf Liner 6 755 795 . 125 3 468
795
I
I
I I
I
I
I
Q
Pump Y ield !!al/min 25
Q I I I
Bail er Drawdown
(!)
Air
I I
I
I
I
Drill stem/Pumo death Duration (hr) I 790 I 1.s
I I
I I
Water guality conce rns?
To
I
Dmcip<;oo
I
Amooo
1 1
11
11
SWL(ft)
I
645
I
I I
I
I
Ground Elevation
1 U-VL..I Y L.l.J
HA V '" '
0 9 ?ntQ
-
v
- - ,_
-- ... ---
uvvnu
From 0 II 19 22 32 34 36 78 89 117 133 150 156 172 175 196 198 208 340
To II 19 22 32 34 36 78 89 11 7 133 150 156 172 175 196 198 208 340 373
D ate Sta rted_3_/_l6_ / 2_0_1_8_ _ _ _ _ Co mpl e ted _3_ / 2_1_ /2_0_18_ _ _ __
(unbonded) Water Well Co nstructor Ce rtification I certify that the work I perfo rm ed on the construction, deepen ing, alte ration , or abandonment of this well is in compliance with Oregon water suppl y well construct ion standard s. Materi als used and in formati on reported above are true to the best of my knowledge and be lief.
Signed
Fl owing Artes ian
3/28/2018
NE IL FAGEN (E-filed)
(bond ed) Wat er Well Con structor Ce rtification
I I I
°F Lab anal ysis 0 Yes By _ _ _ _ _ _ _ _ __ 0Yes (describe below) TDS
Temperature 62
I Fmm I
Q
+
25
License Number -'l-'-9-'--70-'-------- Date
(8) WELL TESTS : Minimum testing time is I hour
Ht----6-45--.1
Est Flow SWL(psi)
To
645
Sandv toP so il Broken lava Brown SS Broken lava lava Broken lava lava Brown SS lava Brown SS lava Brown SS lava Brown SS lava Brown SS lava Brown SS lava
I
Dry Hole? O
Mate rial
Filter pack from _ _ _ ft. to _ _ _ ft. Materi al _ _ _ _ _Size _ _ __ Type
From
(11) WELL LOG
Ca lcul ated
D Yes
3/2 1/20 18 1
I
Explosives used :
SWL Date
SWL(psi)
Depth water was first found 645 .00
WATER BEARING ZO ES
Special Standard
ft . De pth of Comp leted We ll 795 .00 BORE HOL E Dia From To Materia l 12 IBentonlle 0 42 .5 42 .5 8 795
- - - - - --
E/WWM Range 14 .00 E Tax Lot _ _ _ __
1/4
(JO) STATIC WATER LEVEL
Oirrigation Ocommunity
0Thermal Oinjection 0
1/4 of the SW
- - - - - ----
D Other------------
0Reverse Rotary
Twp ...!2.QQ___S_ _ N/S
SW
Tax Map Number - - - - - - - - - - - Lot 0 Lat " or 44 .08 127943 --- --- --- - - - - - -- - - - - DMS or DD 0 Long _ _ _ _ _ ' _ _ " or _31_2_ _ _ _ __ DMS or DD (9 Street address of well (' Nearest address
Rotary Mud Ocable 0Auger Ocabl e Mud
(4) PROPOSED USE
22
125620 ALFALFA MARKET RD, BEND OR
(3) DRILL METHOD [8)Rotary Air 0
(9) LOCATION OF WELL (legal description) County DESCHUTES
I "'"
I accept responsibility for the construction, deepen ing, alteration, or aba ndonment work perform ed on this well d uring the construction dates reported above . All work performed during thi s tim e is in compliance with Oregon water suppl y well construction standards. This report is true to the best of my knowledge and belief License Number 1255
--------
Signed 1
Date 4110120 18
WIL LIAM AIK EN (E-fi led)
Contact Info (opti ona l)
ORIG INAL - WATER RESOURCES DEPARTMENT THI S REPORT MUST BE SUBM 11TED TO THE WATER RESOURCES DEPARTMENT WITHIN 30 DAYS OF CO MPL ETIO
OF WORK
Form Version:
Page 3 of 3 WATER SUPPLY WELL REPORT - Map with location identified must be attached and shall include an approximate scale and north arrow
Map of Hole
DESC 61134 DESC 61134 4/10/2018
CDD ARCHIVE COVER SHEET FOR MAS 05/ 15/ 2000 17: 36: 49
1 of 1
EH 001 ARCHIVE
I i H iii i V 1 I i I I i i i H H I H i 0 1 i V Hi I FILE ID
1714220001301EH20000515999001
TAXMAP
1714220001301
SERIAL
131790
DIVISION
EH
SITUS
25620 ALFALFA MARKET RD
HOUSE#
25620
STREET
ALFALFA
CONTENT
ARCHIVE
MARKET
Community Development Department Administration Bldg. / 1130 N.W. Harriman / Bend, Oregon 97701 503) 388-6575 March
29,
1993
Planning Division Building Safety Division Environmental Health Division
WILLIAM TYE
25840 ALFALFA MKT RD BEND, RE:
OR
97701
SITE EVALUATION # F 14382 17- 14- 2200- 1301 25620 ALFALFA MARKET RD,
Bend
This letter is in response to your on- site sewage disposal system
site
evaluation
application.
The site was evaluated on 03/ 17/ 93, install
Standard
a "
Administrative 340,
Division
CONDITIONS
Rules
System",
for
On - Site
and was found suitable to defined
as
Sewage
Oregon
in "
Disposal,
Chapter
71."
OF APPROVAL
The system is sized for a maximum sewage flow of 450 gallons per day.
The disposal trenches shall total
a minimum of 300
linear
feet.
The maximum depth of the disposal trenches is 36 inches. Filter fabric required over drainfield gravel.
The approved site is very specific.
The land surface in the
vicinity of the approved site shall not be altered.
Any
alteration of the approved site or placement of a well within
100 feet of the approved site may invalidate this approval. Technical rule changes shall not invalidate a favorable site evaluation, system.
but
may
require
use
of
a
different
kind
of
March
Page
29,
1993
2
A construction permit must be obtained from Deschutes County Application for a prior to the installation of the system.
construction
permit
must
be
accompanied
by
an
accurately
drawn plan showing the layout and components of the system. The
plan
must
also
show
the
replacement
location of dwelling and other structures, waterlines,
property
line
setbacks
and
proposed area, well, driveways,
other
pertinent
information.
Zoning clearance must be obtained from the planning authority prior to permit issuance. Please
present this
document
If you have any questions, will do our best to help you.
Sincerely ENVIRONMENTAL HEALTH DIVISION Roger W. Everett, Director
eR-
7647,3
Tom
Sloan
Sanitarian
RWE/ TDS/ sys Enclosure
at
time
please
of permit call
this
appropriate
application. office
and
we
1
SITE
APPLICANT
V///
l/4n
EVALUATION
FIELD
rye-.
INSPECTION
SITE
L
EVALUATOR:
SKETCH/ NOT
SUITABLE
p rev e -. p ,
TO
3// x9,. 3 PARCEL
B— T /
7
A717-76= 7
EVALUATION #
DATE SUBDIVISION
FORM
R
71
SIZE /
9„5-09c
S c2d TL / 3o/
UNSUITABLE
SCALE
yu+<
f
v- or ,
ti vt
fryl 1171: , System
type
approved:
Absorption facility:
Initial rA» DARD Replacement . 5779/. 11; 1340 Tank
Size /
Special
Size 3oo r
Min.
Size Soo Sewage
pop 4/94
Conditions:
Min.
6i/,&, f
cflde,G ieE47 » e w
Max. Max.
Flow /
paJC. Q .
Depth Depth s0
3b" 36"
bpp
0,eAn-/2: i6/_ D
SIT EVALUATION APPLICANT
W/4/../ AM
FIELD
INSPECTION
SITE
TYE
FORM
7/ R3 i%/ B
L
SUBDIVISION
Stos/„/
EVALUATOR: / .
T /
Al/ 9r8..)
EVALUATION #
DATE
R/
7
S
t
Notes on mottling,
c? a
roots,
TL
structure,
limiting effective soil depth, % etc.
Texture
Depth
Color
if'O• f'.S
S2/ 15
O- S 3
To
FD"
A.e
G -/{
S
4( 5-
4(` f
0-
g4
S. t
1/
Yl. F.
S_ L.
F
s
tl F, c•
itwtf
2,I
Landscape
notes
Slope
C1/ 9T7
Other
A.F.
I
site
Groundwater ,
LL3/ FIAT Aspect
notes
Comments:
Reason For Unsuitability: (
Include
Rule
Reference)
1//A
layer
loose
rock,
DESCHUTES COUNTY • COMMUNITY DEVELOPMENT DEPARTMENT
LAPPLICATION FOR
EVALUATION NUMBER
ENVIRONMENTAL HEALTH DIVISION
INDIVIDUAL SITE EVALUATION
41312-41312--
1130 NW Harriman, Bend, OR 97701 503) 388-6575
The following information isinquired The quired to complete an application for a site evaluation. Please be as accurate and complete as possible.
7 ;•
NSHIP
1. 30
k / •• •
SUBDIVISION DDR •
A
0
FP
PARCEL SIZE INSQ. FT. OR ACRES
Ind
c/LL//- A'/ /
38- X969 t-,4/- M/a _, l% Y-)'
z
CITYa/ri7/,
SOURCE
a STATE L
ZIP 9 & /
MAILING ADDRESS
PLANNING NOTIFICATION
5e' 5
ar
f, 4, fi:
1
ZIP
STATE
CITY
COMMENTS/ REMARKS
rwa
TELEPHONE
r LG
z,
MAILING ADDRESS',/
3 AUTHORIZED REPRESENTATIVE
TELEPHONE
1 ..
WATER
NUMBER OF ? BEDROOMS
Z.D- A G, - -
NAME OF OWNER
Yc
BLOCK
I OT
!,! n9r
Ali Q54'
//'LC /
4-31- e-/
Arvm-e- of-/ 7ta
CA-X-%-///
i4
3-1-11)
FOR COMMERCIAL USE ONLY TYPE OF USE
DAILY FLOW
FEE
YES
Please answer the following questions: 1. Are there any bodies of water on or adjacent to this property? - ,
ncfr fie.N/.
2. Are there existing wells on the property? 3. Are there any proposed wells on the property?
NO
ur
r 71---
4. Are there existing wells on adjacent property? 5. Will this property be served by a community water system?
0
0
6. Are there any encumbrances which could prevent or effect the installation of a subsurface sewage disposal system? ( Liens, easements)
TEST HOLES ARE: . _
0
CO-'
READY
fn the area below, sketch the parcel showing the location of:
Existing and proposed wells
IAdjoiningroads or streets --
All bodies of water (rivers, canals, ponds)
Property lines and dimensions
Wells on adjacent properties
Location of test pits
Reservoirs and/or cisterns
Escarpments ( cliffs, banks)'
Water -Lines •
N
fes READ
The Applicant agrees that DeslchuteCounty will not be responsible for any problems or denials resulting from Incorrect or Incomplete information supplied by the applicant. BEFORE SIGNING
SIGNATURE OF OWNER/AUTHORIZED REPRESENTATIVE
DATE
17- --- / SITE EVALUATION APPLICATION
z_"
AMOUNT
13 67
4
CONCI' T10NAL USE
IIP
FOR
THE WEST 1/ 2 OF THE SOUTHWEST 1/ 4 OF THE SOUTHWEST 1/ 4 OF SECTION 22, TOWNSHIP 17 SOUTH RANGE 14 EAST, TAX LOT 1301 TL 1400 v
v
00 0
S
89' 59' 30"
W
00660.26
0 000 0 0an000n0
ALTERNATE HOUSE
Irrigatable >
SITE
Oland/ O tp
00000• - • 00
scale: oXISPAfe!
00
1" =
200' no
date:
INvwv
6/ 10/ 92 DRY POND Pffir-
04
1ri
CROSS
FENCE
HAY STACK
YARD
v) • • • • • • — • • • -
JO TL 920
LIGHTNING
TREE
acres'' -
under
irrigation
CORRAL
S
POWER SPLICE BOX IRRIGATION
s
PUMP
POND
IRRIGATION
DITCH
ALTERNATE
HOUSE SITE
PROPOSED HOUSE SITE TL 1302
OLD GARBAGE SITE
ra
P. O. D. EXISTING CULVERT
62. 4o.
2 +\
EXISTING
Old
TL
TL
100
0 0
0
1100
Pit
dirt
ALFALFA ROAD
i
Y
PERMIT NO.
WCOMMUNITY DEVELOPMENT DEPARTMErW
1 5--.3 th !
ENVIRONMENTAL HEALTH DIVISION
ADMINISTRATION BUILDING -
C//
DATE CALLED IN
BEND, OREGON 97701
G%
15031388- 6575
CERTIFICATE OF SATISFACTORY COMPLETION JOB
LOCATION -
ADDRESS/ /`=
CITYAde
J
ir
C_-`/-/¢NAME OF 0 -/
E/E
—
0, LICENSE NO.
A
INSTALL
'/
SEPTIC TANK MATERIAL
EQUAL
TOTAL LIQUID CAPACITY
LOOP
SERIAL
PRES
FILTER SAND OTHER
q` /J
I WIDTH OF TRENCH
TOTAL LENGTH /)
NEAREST
SIDE
FRONT`
LOT LINE
2 INCHES I FEET FROMR
ll`'
TOWNSHIP
SECTION------!
I:- rT" TAX LOT #_ SO) 6.ca.
0 /
NEAREST BODY OF WATER FEET FROMS
LD,
IGre
FEET FROM/
PTIC TANK /
R4 INFIELD
I -
l7
RANGE
INCHES REAR
y /o
r/ / / !
WELL SETBACKS
FEET FROM SEPTICTANK ,.-
7
FEET
FEET
TOTAL ROCK DEPTH
F TRENCH
DEP
11k,
u-/_I
Hiiiiii\
I
ice_
yz.
MUMES
MINIM
444gMU r tal
11111111111
1
I
As -Built II awing Location-
with Referr
in
1
tiall
in
Installer_ _—_ _.__.___. .___
Final Insp. D. tIssued b
li' I
O.
1111
ration of Law
er in . ection waived
purs ant to
I
th .41 es
in
EMMIEIN
4
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IMMESIIIIIIMINIIIIII Et
111111111
II II
1
11. 1. 111111111• 1 CORRECTIONS MADE DAA
CORRECTION NOTICE POSTED DATE -
In accordance with Oregon Revised Statute 454.665 this Certificate is/ issued as evidence of satisfactory tiiffiieed above. I syste at th ovation completion of an on- si s wage disp
C
AUTHORIZED SIGNATURE /' N CONST RUC
ION' ^
pink
5177 ! -
6,
J
DATE //`/ /
J/
J. I r
1
test
nstaller copy
4!
yellow—. r.licant
d: di copy
gold— fi
copy
110
STATE OF OREGON
DEPARTMENT OF ENVIRONMENTAL QUALITY
CERTIFICATE OF SATISFACTORY COMPLETION SUBSURFACE OR ALTERNATIVE SEWAGE SYSTEM %
1, 761"
Permit Number '-'
6' 7
rt__________
11/
Name of owner R/ 7/ 4/17 Mailing address
2
6 >
Installer' s name
Alit/
i
i
-
Sewage -Cesspool license No.
r , -
u
s
r /
r ' -
ddress
a
Exact location of proposed sewage disposal system 25-11167 Bedrooms .-
Total number: Living Units Water. supply: Public system
Community sy tem -
Baths Well
Spring 0
Cistern/ jy
r. 40.AC
Septic tank: Material
Total liquid capacity !/.
p.al
ft
Distance from: Well, springs, or cisternnft. Building foundation Sub -surface tile or perforated pipe disposal field
V
Other
ORTH
Distribution box: Yes 0
N0
Length each line: //
ft
Total length: "'
Se)
ft
f0
ft.
Width of trench: Total square footage:
Distance between lines1® ft
l,[ ffp
in.
Filler material: !TyperSize Distance of sub -surfaces or other type of system from:
Water line Well
ft.
ft
Cistern
ft.
Spring
ft.
Nearest: Riverft
Stream
ft.
Lake
ft.
Nearest lot line:
Front
Side -
Nearest foundation
Rear:
ft.
ft
In accordance with Oregon Revised Statute 454. 665 this certificate is issued as evidence of satisfactory completion of a subsurface or alternative sewage disposal system at the above location.
Date of preliminary site approve J D {/ Date of final inspection
NOT approve
Ki
7
Soil conditions observe Approved /
7
REMARKS
SANITARIAN
White copy— Health Department
Pink Copy— Property Owner - .
DESCHUTES COUNTY
382-4000 ext. 60
Yello • copy— Installer
PERMIT APPLICATION
DESCHUTES COUNTY' BEND, OR 97701 382- 4000
DATE KENNETH E. GLANTZ, BUILDING ADMINISTRATOR, EXT. 252 BILL MONROE, PLANNING DIRECTOR, EXT. 207
BUILDING PERMIT NO
JOHN K. GLOVER, COUNTY SANITARIAN, EXT. 237
11 70 - 7
SANITATION PERMIT NO
0
JOB LOCATION (',{%/ `
z
ADDRESS PERMIT TYPE
0w
0
OzZ_ w
i
4' 1—
CC
RESIDENTIAL
COMMERCIAL
SEPTIC
MOBILE HOME
ACCESSORY
OTHER
ZONE
CLASS OF WORK NEW
REMODEL
e
MOVED
a
USE OF BUILDING
OCCUPANCY
S
STRUCTURE TYPE.
CONSTRUCTION TYPE METAL '
z_
FRAME
OWNER' S NAME& ADDRESS
ili
BUILDER' S NAME & ADDRESS ^
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ARCHITECT/ ENGINEER
PHONE
i NOTES
t1 c r-1 Or Z'
LEGAL 32 TOWNSHIP
DESC
RANGE
SECTION
PLANNING DEPT EX 207
PLAT NO.
TAXCOT NO. X1413
7y' - I>
15
1e
LOT
SUBDIVISION NAME
BLOCK
OR SITE PLAN NUMBER
PRESENT USE OF PROPERTY
13 ACREAGE
ZONE
USE OF BUILDING ( DESCRIBE IN DETAIL) SETBACKS
FRONT:
0
SIDE:
0
NOTES:
14
REAR:
PERMIT NUMBER
7'
OO
SIZESIZE OFOF SEPTICSEPTIC TANKTANK `: `:
1.
2.c...., .. Vii. / r" 1i1i,. ,._ _,•_,•_.._.._
1i -,..-:;<•'
td *..,
SANITATION DEPT EX. 236''
17
GALGAL
NUMBER OF BEDROOMS NOTES' -,.-
2'
7 " / ,/ ?— - %
SQUARESQUARE FEETFEET OFOF SIDEWALLSIDEWALL
3
7• 1 /
D WATER SOURCE (
G a6 -
r','%
7 7
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c•.>_..
c, i
I CERTIFY THAT ALL LABOR IN CONNECTION WITH THE CONSTRUCTION OF THE SEWAGE DISPOSAL SYSTEM WILL BE PERFORMED EITHER BY A PERSON LICENCED UNDER ORS 454. 695 OR THE OWNER.
SIGNATURE OF OWNER/ INSTALLER X
7/% rj_ A'
S:-....._ ,-
17 -?
7.e VALUATION
PLANNING DEPT APPROVED/ DENIED BY
I
AGREE
TO
BUILD
DATE
BUILDING CODE
ACCORDING
TO
ABOVE
DESCRIPTION, PLANS & SPECIFICATIONS AND THE
OF
DESCHUTES
PERMIT BECOMES NULL &
VOID
COUNTY.
BUILDING SURCHARGE
20
22
22
THIS
IF WORK OR
PLUMBING
24
CONSTRUCTION AUTHORIZED IS NOT COMMENCED
SANITATION DEPT
WITHIN 120 DAYS, OR IF WORK OR CONSTRUCTION IS SUSPENDED OR ABANDONDED FOR A PERIOD OF
APPROVED/. DENIED
120
DAYS
AT
ANY
TIME
AFTER
WORK
COMMENCED.
DATE
H.
c `' W
BUILDER CERTIFICATION
NO.
PLANS CHECKED &
APPROVED
OWNER OR AUTHORIZED AGENT
IS
SURCHARGE
25
NOTIFICATION
2e
SEPTIC
27
OTHER
28
PLANS CHECK FEE
2e
MOBILE HOME
30
TOTAL FEES DUE
11
BY DATE
X
RECEIPT NUMBER
32
T. L.
LOCATION:
S
1_ 1_ 2,
SLBDIVISION:
2
LOT:
WNER' S
TEST
BLOCK:
to
NAME:
400Ce-
x4er
HOLES EXAMINED
92 = MIL
Tca ,e
uz 30+
sciwri
WATER TABLE:
631--a,- 1 13 cjMd IoQB(.
WATER TABLE:
MOTTLES
CHROMA
MOTTLES
CBROMA
RESTRICTIVE LAYER:
RESTRICTIVE
TERRACE
TERRACE LEVEL:
LEVEL:
LAYER:
SUFFICIENT AREA ON LOT FOR INSTALLATION OF SEPTIC TANK AND DRAINFIELD?
RECOMMEND:
APPROVAL
INSPECTED BY:
REMARKS:
X.
a
5 ctIANnrrcL
YES )(
NO
DENIAL.
L---
DATE:
t
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DATE
BLDG PERMIT #
SEPTIC TANK PEERM.*
COMMUNITY DEVELOPMENT DEPARTMENT •
7 L8/J
HEALTH DIVISION
ENVIRONMENTAL
W
1," i °
i
DESCHUTES COUNTY
RE
COURTHOUSE ANNEX - BEND, OREGON 97701
EI
O
0
I Vi
NO.
2) '75a
503) 388-6561
SEPTIC TANK PERMIT APPLICATION LOCA
ADDRESS TION
Z.->'
CI TV /
C/
AT/ As-i--J--2.2.4^ ,
S/a/" V/.. d
DESCRIPTION
7
TOWNSHIP /
RANGE /
Z
SECTION .
1
SUBDIVISION NAME /
OWNEADDRESS !
Z '
7ro
PHONE gg- z&g3 j
flr
7iJ-rT i% A t v- f'cir-7
EXCAVAT NAME
BLOCK
LOT
LL/ A 14
G///
ACREAGE lib
13O Z
TAX LOT NO.
S
vZIP
STATEO.2
CITY./ r/a
z [i(
9770/
S
K
PHONE
LICENSE NO.
ADDRESS
NIUMBE9 EVALUA ON _
J.- /
9( b - 79
NUMBER
o'
p/
SYSTEM USAGE
Z
BEDROOMS
c7R.G< rl
2N
ZIP
STATE
CITY EXISTING PERMIT £
STE
u0-. L`LG--
WATER SOURCE
NOTES:
I CERTIFYCERTIFY THATTHAT THETHE ABOVE ABOVE INFORMATIONINFORMATION ISIS CORRECT.CORRECT.
I CERTIFYCERTIFY THATTHAT ALLALL LABORLABOR ININ CONNECTION CONNECTION WITHWITH THETHE CONSTRUCTION CONSTRUCTION OFOF THETHE SEWAGESEWAGE DISPOSALDISPOSAL SYSTEMSYSTEM WILLWILL BEBE PERFORMEDPERFORMED EITHEREITHER BYA.BYA. PERSONPERSON LICENSEDLICENSED UNDUND
RR ORSORS 454.454. 695695 OROR THETHE OWNER.OWNER.
XSXS
SIGNATURESIGNATURE OFOF OWNEROWNER
1 CERTIFYCERTIFY THATTHAT I AMAM CURRENTLY CURRENTLY LICENSED LICENSED UNDERUNDER THETHE DEPARTMENTDEPARTMENT OFOF ENVIRONMENTALENVIRONMENTAL QUALITYQUALITY RULES.RULES. XX
SIGNATURESIGNATURE OFOF INSTALLERINSTALLER
SEPTIC FEES
PLANNINGPLANNING DEPARTMENTDEPARTMENT STANDARD SYSTEM
f 6( 4b
ZONE ',
120. 00
EVALUATION OVER 180 DAYS
A)/ W -
FRONT
60. 00
EVALUATION WITHIN 180 DAYS
STRUCTURAL SETBACKS
ALTERNATE SYSTEMS
SIDE /
REAR
CAPPING FILL
240. 00
SAND FILTER
280. 00
TILE DEWATERING
120. 00
SEPTIC TANK AND DRAINFIELD APPROVAL ONLY-
DOES NOT CONSTITUTE BUILDING
RENEWAL
10. 00
ALTERATION
95. 00
AUTHORIZATION NOTICE
25. 00
OR USE APPROVAL.
SIGNATURE INDICATES COMPLIANCE WITH APPROVED_
1
PLAN. p+,,,,
PLAN SIG. %
COMMERCIAL GPD j"
2 "
3J
DATE '
9
OTHER
CJ COMPATIBLE WITH CURRENT ZONING
5. 00
DEO STATE SURCHARGE
OTHER .
V
REPAIR
35.00
EVALUATION OF EXISTING SYSTEM
60. 00
PLANNING
10.00
TOTAL
X31
OFFICE USE ONLY DENIED
PERMIT
EQUAL
MIN. TANK
FLOW DESIGN
CAP. ( GAL.)
APPROVED
LOOP
SERIAL
PRESSURE
GPD
TRENCH LENGTH
LINEAR
1 FABRIC 0
DEPTH
SPECIAL INSTRUCTIONS:
THISP
DATE
SANITARIA./
s_v= 'Y
7
G
RMIT
FIRES
R —. 2
AUTHORIZATION NOTICE
THIS SYSTEM IS SUITABLE FOR
2/ 6-0 GALLONS / DAY AND 15 CURRENTLY OPERATING PROPERLY. FILE COPY
FEET
TRENCH
OTHER
SAND FILTER, FILTER
INCHES
alr
APPLICATION
DEPARTMENT
OF
TO
ENVIRONMENTAL
QUALITY
FOR
EVALUATION PEPORT. OF SUITABILITY OF FROPOSED SEWAGE DISPOSAL
DESCRIPTION OF PARCEL Suction _
2
L: ttach a Plat .: r Mq' Snaa' w All Sita. as F,:hbCt A)
17S
i '.x.rnrhip
Ranya
toy' County of
U2• 1Claltlbll MP
larrnti.va Oeecriptioa: 20 acre parcel (:.'
PROPOSED USE OF PARCEL (
Residence
ib:3IDEITrAL -
on
20
A- 1
lot
parcel
ZONING, AND NAME OE DESIGNATING AGENCY
by Deschutes County Commissioners
PROPOSED METHOD OF SEWAGE DISPOSAL ( 1
Tax
OT/ E7? IsererrvI)
acre
PRESENTLY DESIGNATED LAUD USE,
Or.+Jon;
79- 152
Check one and Provide Requested Information)
EXISTING SEWERAGE SYSTEM ( Fee:
2)
55 for one lot, 510 for two or more lots)
Parcel is located Ld thin the bovndztee of and can ba provided sewerage service by the following entity which
owno
and operates
a
seOerage
system:.
Nana of Entity Spites.
Identification
Address of Entity
City, 2)
zip Coda
HEY PUNCHED
Present status of eewere or sewer extensions to carve parcel:'
3)
a)
Plane for reward (
v)
Piano for sewers ()
c)
Swore ( )
I
have () have (
Pure not been prepared.
OOT V'ir I 2 2 197(]
1 Fwd not been approved t+y DEQ.
have no
have ( )
bran installed.
17
STATEMEX7 OF CERTIFICATION BY SSW! tRAGE SYSTEM C9.'irR ( Separate statement may be attached if available). As representative of the owner o: the sewerage system named in ( 1) above, I hereby Certify that sewerage service will be provided for the above described parcel.
that said sewerage system hes capacity to serve the parcel and that
the above information relative to the status of such sewerage service Is correct to the best of my knowledge.
Signature of Reprasantativa Title Data
I
F
TSFJ 7:_
d E.
i
SR: C,c SY= TD ( Fee: +
Thr :
ne
h.:
5:: .
or
coed :' a : rcp:sed ejetem rrer:c: ely in '
tae -'
r
too
or• more 1
ting? (
lots)
No (
e := I iss-ue_' a :' seta L: schr; a Perm' o. J}ir ( the proposed system? ( si:'.ArE
DISPOSAL $ .:
Thep (
Ye.:
SJO
per
J
Teo,
on (
dace)
1 Noyes. Permit no.
ler)
Srov lomtian of prposad eubeurfaee syetun or systems on the prat plan for each site which is attached as Exaibit A.
1.
For a subdivision of roar or more sites, attach. as Exhibit b:
A topnraocical rap
do: a
Special
2.
Rates of slope data
s: a'fa_e eni e:: baw,'_re)
7. _.
5. .
3.
Soils data
a er
4.
Water table data
ply SJCPCe and diatribntion system
i'_y sabers arca LOWC.1e disposal eye; e a : ocation
Its-- = ion:
OEc a: d/ err its
ntract agent most complete a site investigation before a report can be glean.
To
facilitate s_ c.: inveatigatloa, prepare two 121 backhoe test -holes at least 1cft. deep and
aper -.: mately 75 ft. Apart ( at the saw.- approximate gronrA surface elevation) at the site of each proposed
Test
system.
hoar ( )
have been prepared )..
3 will be prepare? i — 27/4G "'
I EINE ATTACHED THE RIC, CHSU H{ HIJ: TS ANU FES SPECIFIED I:: Ti*: RE, UEST FP SEWAGE
T.. T- CEPA CtC;J:
DISPOSAL ? DR
Cr
Tb. JOVE
ENVIRCBMEntA1. QUA:. I ( DESCRIBED
C,
rlel(ial_ ''
A R1_PCRT OF ScITAa: LITY 4P TTF!* Hoe E r :'
CRI
MET ,
Og
PARCEL.
Pare of 4- p icrt P ytnr : ` Kori _ sea- ann of ni2n2. 25800 Al Pal fa Mkt city, State,
ti %_
I:: S.':111CTt( 1: 15 AND ON TI15 A:• BECAT! 1 AND HERETY
Sivrctury of Applicar
Road q // //
97701
Of
P: ovy
t _. 4_ 712_ Dete
Connects a: d reroraendattons based on Subsurface Site I - ars tigation by DEG or Contract Ayant:
This parcel has been evaluated by a member of this department.
Studies including but not limited
to soil conditions, water table circumstances and topographical variations
were
conducted.
It
is
the opinion of athis department that parcel. it is feasible to install a septic tank and subsurface drain field to serve residence on this This evaluation report shall remain in effect until
issuance of a permit to construct, unless in the meantime conditions on subject or adjacent properties have been altered in any manner which would prohibit issuance of a permit in which case the evaluation report shall be considered null and void. i DESCHOrn num Darr. Or HEALTH Jay E LangleY_ a R 10i2jj9 OeSche'sLbuRty lAA;r!hrrea % Raney t
1
ATenr/ ns,--
BEND, OREGCrba1bync of Cir.: or Agent 2e. z:_ ite to Atc' e : pplicatitm x
The
described
I 1'
The
Jeocribei r:.. w
model
of ..-.-
m,, dispersal
coasqe . ..
a-
anrcrted
is nbt epnrceelfur
the follow:
reams.,
Or.e building site approved subject to the following conditions: 1.
The solid in the proposed area of the drainfield and the replacement area cannot be. altered except as a condition of the permit. A permit is required and must be obtained to constructing the system.
from the Deschutes County Health Department prior
DESCHUTES COUNTY DEPT. Or HEALTH Deschutes County Courthouse Annex BEND, OREGON . 97 701 =.: F' res.... _
t.- -`+
t ""
gee :, r. _ Jai E• _ Langley,. -R - S.--- -DEQ, Agent Representative
10/ 2179 ___
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SUBDIVISION:.
BLOCK:
LOT:
OWNER' S NAME:
s
R w .,
7
T
LOCATION:
Ba
1
oorP,
TEST HOLES EXAMINED
lit 314-
TaadS
112 30'x`
eChnel
SC, (
CHROMA
MOTTLES
CHROMA
MOTTLES
RESTRICTIVE LAYER:
RESTRICTIVE LAYER:
TERRACE LEVEL:
TERRACE LEVEL:
SUFFICIENT AREA ON LOT FOR INSTALLATION OF SEPTIC TANK AND DRAINFIELD?
INSPECTED
APPROVAL
BY:
X
tlac(
YES
Ir NO
DENIAL
DATE: (
L--,
f REMARKS:
IOa
WATER TABLE:
WATER TABLE:
RECOMMEND:
Sann-
cl- ciel
I
0 - 1- 77