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. . . . . i- :: ': ::: : : : :: • .. .. • . ; . . :- - . . . .. •. ••••• - •. . .... .. . ... .. . .. ... ... .. .. :: : • •'Oregon DepartmentOf Environmental Quality '..! ..: !! .:.; -: ..i. ::.i „i ! •• .• •• : • •.. .. . .. . • . . . . . ,". • i:: .: ".::".: ;•,„ -: •.!": •:. :.;: ::: :: *, :: „i :: ;: : !: !: : : ' •• . . : : ::: :.: --. : !:: : •-• ::: :• :•: :i :: •• •i :: .... ::. i! :: .• : : • . . :::• ..:..• . ': :!' ::. ''.•i 14 General System Information ', :-: '•; I; •.i ;: ;; ;: • ..": : :• - ; . .. . . . . •: :. •-• ;i; .;.• The Existing System Evaluation Report form contains 8 pages*;Some of the questions on this; : • • .! • • :.:i:: :' form may not pertain to the system being evaluated,as there'i are many system designs.If you.:(the • septic system evaluator)are unable to answer any of the questions on this form please indicate,in •:::: writing,why this information Was:not•ivailable at the time the evaluation was completed. ' ..... . ... ... .. .. ..... ... .. .. .. . .. . .. .. . -• i i• :: ::.•:E ••••• •i•: .. .i: :." i:: :.:i E• :• ••: •• . • .. iii„ The existing septic system consists of(check all that apply) . .. • • . • -•• • • - - • • • . . . . • Septic Tank ..: .. :. : -: ! . ."0 Cesspool - .•• . • • •• • • . . . . :Dosing Tank:.:i :. '... : .• . ::Eli DiSpos4 Trenches/Leach LineS • !:. ;! i:: : - Multi-compartment Tank ; :.! - .:0 ii Capping Fill • . ID Seepage: tied;' *: :! -' .i ..:0 i: Sand Filter : • - - - • 0 Other I: ;.••• .: .: :' • Il •• . :F. : ::. : : :: .: .:- ;:.-. i:i i:. :: •.: '.; •• :: • ii ii : •. :: • . .. •. ... . ... ... . .. .. . .. ..... . Note Cesspools may be used only to serve existing sewage loads and if failing only be replaced with aSeepagelpit system on.lots that are too small to accommodate a standard system or other alternative Onsite syStem::. ::: ::: !:: :: .: ':: i :. i... There is a permit for the septic system Yes Olio []Unknown • . :. . • • • , .. • . . : • Permit Number(s):ezz—6.-4,3).. -co:: . ... • : . : . .: :. .. : • • Year Original septic system installed: ••2 dig,z, !.(YYYY)11 ! EINo record of installation date • •• • i:: :: :ii::i ii• Dates of subsequent repairs or alterations '---t--- - (YYYY) . . . .. .. - : : • -• ••.. . : i:. All plumbing fixtures are connected to;thejseptic system Oyes [ No Othilmoisyn • '.' : :. : .: If you answered'No"or" own,"please describe below ::* .:1 ' ii!:::: ;:. ':•; i2e%'. ./j',i ; ::. blz24.5el__c;; ,‘carlied i. 1P:1 : . .: -.: . • .•• : .., i'i • i:i;; ::. ::; .. :: :: ;; .: • •.. . : • ..::- -• •- ::: • • ••. . . • • - - - - - • . . . • . . •. • . .. . • . 2 :i •: Additional Conments:-- :: : •:: :: :: :: :: :I :-. . :: . • - ••. .. : •. .. .. : . . . .. . • . .• • .. .. . . . . • • • . „. . • •• ::: :: •:::: • - :: :-. . ... : . . . ":: .•••i - : • 2: Overall Septic Sy4eni:Stat4s i„: •ii '': ': .• 1:: i: : •• - .. . . . . - . .. .• - . - -• - ..: Discharge of sewage to:the ground surface ['Yes::Elio Clilione observed . .• . .... .. . . .. . .. . .• :":" :; '..!:.:: i!.. Discharge of sewage to surface waters: ElYes:: KNo 0 IstiMe observed "• .: ;:. : :. :: .• :•::i - •:: .: .- ::: :. :-• .: :- ': •-; :: ;.• i • Sewage backup into plumbing fixtures- ['Yes:••E0o Elli.n.fmown • -• . • . . . • .•• ••• - •• -- - • ••• - • -. -: „: ;: : ::::: : .. .• - - • •• Additional Con:merits:-': :: . : •:: ::: : ••: .... .•. • :.. .- :: : -: :: :: :::::- • :: :•: - •• : . : .. . . ... . . . ... .. .. ... • • • . •• ::::: : .• :. . . . ... . .. . . : . ,. : •.. • . . •.. . - .:. •. . .. ... . - •• - ••• - •• - •• •-• • "" . . . . .. . . .. .. . .. . . .. ... . . .. . ... .. .. ... .. . . .. . .. . •- • -- — • . . ..„„ „.. •i:. il ili 1:.;..:„ .:. S'eptf.L tank II! H'.. ::: ''..! ::! ':i.. i! .'; i '.... in i• . . . • - • '-.' :" :.E :.i :E ,.. ':•.' 7. •••:.. :.:... .:.•• :- • :. .,, : i •• iF • : . .. - •• •• •• • . . . . In order to fully describe the condition of the tank,the septic tank may need to be ptimped.Please : • •indicate below if the septic system tank was pumped during the course of this evaluation. . •. • • Septic tank was pumped during the course of this evaluation :Ores ONo . : . • • .•. . . . .• #.: If the septic tank was NOT pumped during the.course of this evaluation,please explain(e.g.' • •. . . . .... ::. ...i :: : -.• septic system owner declined to have the tank pumped etc):F:::: : : • - . . •• •-• :. .,• . - • •. .• . . . . . : :. •.., .. . - . -- :: : : ::: •:. -.- -. ::. :: :: Page 2. .of 8 • :',' ' • . •. .. . : • • :i..: . • - • • - . :: .: • .. ... :.: ,.. : ::: ,.-si ••i :.. :.: • ,. :, , .. ... ,, •„; : .:, , , • . • •• .. . . .. : • • - .... ... ... .. . . .. .. .. ... . .. .. .. . .. . . ,.. . . . .. • . . . .. . •- :....: .•;•. • „.. ::: ,-.: :: „L :: •• . - • . .. .- . • • . :• ... . •: :•• •. .• .• •. : .: •• i: : . - • • -•. .. . . . . . . • • • - -.- • • - •- ••. . • - - - - • - •• • •• • • • .