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Seller'sPropertyDisclosure
Septic
Certificate of Satisfactory Completion
Deschutes County
117 NW Lafayette Ave. PO Box 6005
Bend, OR 97708 541-388-6575
cdd-webmaster@deschutes.org
Website: deschutes.org/cd
Date Certificate Issued: 11/01/2021
Work Description: new SFR changed address
Address:
Applicant: steve humphreys PO Box 687
Oregon City OR 97045
Phone: 5037100960
Email: shumphreys@coffmanteam.com
Owner: THOMPSON LIVING TRUST
Address: 19823 COPERNIUS AVE BEND OR 97702
Primary Contractor: Coffman Excavation, Inc
Installer License: 35524
Address: PO Box 687
Oregon City OR 97045
Phone: (503) 710-0960
Email: shumphreys@coffmanteam.com
Date Certificate Issued: 11/01/2021
Work Description: new SFR
changed address
Conditions of Approval
·Vehicular traffic and livestock must be restricted from the system area.
·All roof drains must be directed away from the system
·Meet all required setbacks
In accordance with Oregon Revised Statute 454.66 and Oregon Administrative Rules 340-71, this Certificate is issued as evidence of satisfactory completion and installation of components as described in the permit at the location identified.
Certificate of Satisfactory Completion
Comments: Yes No
System Inspection: Operation of Law - 7 Days Notice: Pre-Cover Inspection Waived Per 340-071:
Conditions of approval specified in this document continue in force as long as the system is in use, (OAR 340-071-0160(5))
Completed Inspections
Inspector
Inspection
Inspection Result Inspection Date
Kevin Hesson 7020 Pre-cover 10/29/2021 Approved with Conditions
Kevin Hesson Environmental Health Specialist
CALL BEFORE YOU DIG...IT'S THE LAW
ATTENTION:Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth by Oregon Administration Rules. You may obtain copies of the rules by calling the center. (Note: The telephone number for the Oregon Utility Notification Center is 1-800-332-2344.)
No
AS.BUILT FORM
1Es All septi. system inspections are to be requested through Oregon's ePermitting system at http://aca.oregon.accela-com/oreg(
or by phone at 1-888-299-2821. Use the site spe(ifir permit number when calling. Complete and submit this form to a DeschL
County Community Development Department (CDD) offace prior to the preroyer inspettion. lntomplete or inaccurate forms w < not be approved. Onae a complete and accurate form is submitted and an inspection is scheduled Desthutes County has sev( days to complete the inspec on. Use the spare belowforthe As-Built drawingand completethe Materials Listing sertion and lnstaller lnfo section on backside ofthis form. This form can be emailed, dropped-off, or mailed to a CDD office:
ril: d: mond: ine: onsite@deschutes.org
117 NW Lafayette Avenue I PO Box 6005, Bend, OR 97708 city Hall, 437 sw 9,h st, ste 202, Redmond, oR 97756 r6345 Sixth 5t., La Pine, OR 97739
rIC PERMIT # MIT.|OB ADDRESS
AS-BUILT DRAWING
,v at LEAST the followinS: North arrow, all system ma.ior components (see back side of this form for major components), proposed & existing cent structures/driveways/utility lines, future replacement area(s) as shown on approved plot plan, and lengths of drainlines & effluent transp :rs.5how distances between system tomponents and to wells, structures/driveways/utility lines, and nearest property lines & bodies ofwater :hin 150' of initial and reserve system arcas. Note existing septic system rcmponents such os tonks, droinfields, etc. os "existing".
INSTALLERS COMPLETE THIS SECIION:
Business Name o
DEQ Certifi(ation # of Signee:
Permit # I certify the information provided in th
regulati Name: ng the const
Septic Tank
Construation ! Pro owner;or E Licensed D.E lnstaller is noti(e is aorre(t, and that the construation ofthis system was in a(cordance with the permit and rules ctaon of onsi sewaSe dis salsystems (OAR Chapter 34O, ions 7 731 PRINT
MATERIALS LISTING SECTION: IisI
Manufacturer:
DEQ License #:
9d 3E
Oosing Septic Tank (Two Compartment)
Dosint Tank
Effluent Filter
Drain Rock Perf Pipe Yrds FT
Manufacturer:
trFlow-Thru or C Baffled (up & over sanitary tee) Gallons
Manufa(turer
Manufacturer
Supplier:
Filter Fabric tr Hancor Arc l8 (5'(hambers)
Nlodel#:
Supplieri ASTM #: Manufacturer Diameter: inches Fabri( Type
Che(k One: # of Chambers Wire Mesh tr lnfiltrator (4' (hambers)
(7'2" chambers) FT
EZ Flow FT FT So Supplier
Effluent Sewer Pip€ (Gravity or Pressurized)
Tra<er Wire (Min. l8gauge, Green)
Switching Valve # of'. sprin8 Check Valve # of:
Drop Boxes # of Distribution Boxes # af Overflow & Header Piping
E Dosint Timer
ControlEox
Swing Chcck Valve Anti-Siphon Valve #of #of # ofl
Supplier: Mesh Supplier:
F Model 1201P (Single.ylinder installation in each draintine); or O Model 1202P (2 side-by-side cylinders installed in each drainline)
Manufacturer: Typel
Supplier: Diameter: FT
Manufacturer:
Manufacturer: ASTM # inches FT
Manufarturer: Eltoncrete or ElPolv
Manufacturer Supplier: Manufacturer Manufacturer Manufacturer Manufacturer
Capping Fill Drainfield Material
Pressurized Drainline Piping
Supplie.:
Diameter inches (t FI ASTM #:
Pump Packages Yrds Supplier
Supplier: Diameter FT 9"a t- o-
ATT Unit # of units:
Filter Fabric (lf not "stit(hed" onto cylinders bv manufaatrrrpr) # of: 7 -
Manufa(turer Supplier:
Oimensions
Filter Fabri( Liner Size:
DEQ Pea Gravel
DEQ Sand Media
Pre!surized Laterals orifice spacing
FTIFI SidewallMaterial
Sq. FI Manufacturer: Manufacturer: Yrds Yrds FT FT
Supplier:
Model#:
Model#:
Model#:
Model#:
Model#:
ASTM #: in(hes
Make/Model#s: tr%" OSB (all edges sealed) tr%" Plywood tr Designed by prof. Engineer
Supplier: Pipe Supplier: Pipe Diameter
Model# inches
ASTM #:
SITE COVERAGE:
LOT SIZE: 2.50 AC 100.00% LOT COVERAGE
PROPOSED RESIDENCE FOOTPRINT AREA: 3706 S.F. 3.40%
OUTDOOR COVERED AREAS: 673 S.F. 0.62% TOTAL: 4379 S.F. 4.02% COVERAGE
PROPOSED DRIVEWAY: 5049 S.F. 4.64% TOTAL: 9428 S.F. 8.66% IMPERVIOUS AREA
NOTES
- PROPERTY IS FURTHER DESCRIBED AS LOT 83C, RIVER BEND ESTATES REPLAT OF LOTS 82, 83, 84, 85, 86, 878, 113, 114, 115, 119, 120, 121, 125, 127, 128, 129, 130, 137, 138, 139 & 140. - THIS IS NOT A BOUNDARY SURVEY -ALL PROPERTY LINE DATA PER "REPLAT OF LOTS 82, 83, 84, 85, 86, 878, 113, 114, 115, 119, 120, 121, 125, 127, 128, 129, 130, 137, 138, 139 & 140 IN RIVER BEND ESTATES" LOCATED IN SECTIONS 23 & 24, T18S, R11E, AND SECTION 19, T18S, R12E, W.M., DESCHUTES COUNTY, OREGON.
- SEPTIC APPROVED AND INSTALLED PER 247-21-000845-PRMT. - TOPOGRAPHY AND TREE INFORMATION PER EXISTING CONDITIONS AND TOPOGRAPHIC SURVEY BY H.A. McCOY ENGINEERING & SURVEYING, LLC (JOB NO. 21-124).
- EXISTING AND FINISHED GRADES TO REMAIN THE SAME WHERE POSSIBLE (TAKING SITE CONDITIONS INTO ACCOUNT).
- ANY AND ALL GRADE CHANGES WILL BE MINIMAL AND ±2'-0" CUT/FILL MAX. -ALL STORM DRAINAGE TO BE RETAINED ON SITE. - (R) =PER RECORDED REPLAT - (M) = MEASURED
CCR's
