Laserfiche WebLink
Oregon Depaitment Of Environmental Quality <br /> 1. General System Information <br /> The Existing System Evaluation Report form contains 8 pages.Some of the questions on this <br /> form may not pertain to the system being evaluated,as there are many system designs.If you(the <br /> septic system evaluator)are unable to answer any of the questions on this form please indicate,in <br /> writing,why this inforrna.tion WaS not available at the-time the evaluation,was cornpleted, <br /> • The existing septic system consists of(check all that applY): <br /> 0. Septic Tank Cesspool <br /> Ei Dosing Tank Disposal Trenches/Leach Lines <br /> IZ Multi-compartment Tank g Capping Fill <br /> D Seepage Bed 0 Sand Filter <br /> 0 Other <br /> Note:Cesspools may be used only to serve existing sewage loads and lrfaiting only be replaced with <br /> a seepage pit system on lots that are too small to accommodate a standard system or other alternative <br /> :onsite system. <br /> There is a permit for the septic system IYes 0No []Unknown <br /> • Pennit Nuinber(s) Q. . DEA-.35. <br /> • Year original septic system installed: 2_005 (YYYY) 0No record of installation date <br /> • Dates of subsequent repairs or alterations: (YYYY) <br /> • All plumbing fixtures are cormccted to the septic-system IgYes :No 01.1tiodown <br /> If you answered"No"Or"unlaiown,"please describe below: <br /> ,e-ex <br /> • Additional Comments: <br /> AI I fs .ovx tr).71/e... beevi AKA <br /> Oge.,C4A,L) Cott-Lc:41/. <br /> 2. Overall Septic System Status <br /> • Discharge of Sewage to the ground surface OYes RI:No lidNone observed <br /> • Discharge of sewage to surface waters [Yes [KNo ZNone observed <br /> • Sewage backup into plumbing fixtures ElYeS gNo OUnknown <br /> • Additional Cormtents: <br /> 3. Septic tank <br /> In order to fully describe the condition of the tank,the septic tank may need to be pumped.Please <br /> indicate below if the Septic.system tank was pumped during the course of this evaluation. <br /> • Septic tank was pumped during the course of this evaluation 0Yes ]No <br /> • If the septic tank was NOT pumped during the course of this evaluation,please explain(e.g. <br /> septic system owner declined to have the tank pumped etc): <br /> Page 2 of 8 <br /> 1 <br />