1988 020 Ordinance - Laserfiche WebLink

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CUYAHOGA COUI~TTY HEALTH DISTRICT 112 HAMILTON AVENUE, CLEVELAND, OHIO 44114 n (216) 443-7520 ~~_"-~'-~ APPLICATION FOR HOME SEWAGE SYSTEM EVALUATION A. ADDRESS OF HOME: CITY: B. NAME OF PERSON TO . PROVIDE ACCESS: PHONE # 1. SELLER'S NAME: PHONE # MAILING ADDRESS: CITY: 2. BUYER'S NAME' MAILING ADDRESS: CITY: 3. BANK OR TITLE COMPANY: ATTN: MAILING ADDRESS: CITY: ****CIRCLE THE NUMBER CORRESPONDING TO THOSE RECEIVING RESULTS**** ---------------------------------------------------------------------- 4. The fee for this service is $100 and is NOT refundable once the sanitarian has been out to the property. This prepayment does not include system preparation for evaluation. It wil I be necessary for the applicant or their agent to expose the following prior to the sanitarian's inspection: Access cover used to clean the septic tank Access cover for the flow diversion box Access cover for the sampling chamber Other ( ) (The installation date will normally dictate those items to be exposed. If this form has been mailed especially for your address, the appropriate items will have been checked off. If NOT, you must verify these items by phone.) 5. The person who will be providing access to the home WILL be contacted by the sanitarian AFTER he has received the completed application. Please wait for his call. Adverse weather conditions will unavoidably~.~ ; delay completion of the evaluation. 6. The sanitarian will only arrange or conduct the evaluations Monday thru Friday from 8:30 a.m. and 4:30 p.m., please make sure that the person providing access to the home can be available during these hours. The phone numbers listed above should coincide with normal offices hours. 7. No evaluation will be done on a home that has been unoccupied for more than 30 days. Evaluation can proceed after the home has been occupied for 90 days. 8. In some areas, buyers and sellers have agreed to put sufficient monies forsystem repair in escrow to permit closing when weather or other factors have caused unavoidable delays. Contact your real estate agent, banker or lawyer for more information on establishing an escrow account. You should contact licensed sewage system installers for estimates on current system repair prices. 9. The opinion rendered by the Board of Health regarding the septic system applies only to the date and time that the evaluation was made. This opinion does not guarantee the future indefinite performance of the sewage system. This opinion is also rendered with the expectation that the system will not be loaded beyond its design capacity and that routine maintenance will be performed. 10. The Board of Health will issue orders for system repair or replacement when the current system is found to be creating a nuisance or poses a potential public health hazard. I have read, understand and agree to the conditions stated on this form. (Current Owner's Signature) (Date) NO EVALUATION WILL BE CONDUCTED WITHOUT THE OWNER'S SIGNATURE