Laserfiche WebLink
( 1 <br /> Oregon Department of Environmental Qwallty <br /> 1. General System Information <br /> The Existing System.Evaluation Report form contains 8 pages.Some ofthe questions on this <br /> form may:not pertain to thaSyStani being,eve,as aremany system&Signs. <br /> m evtal" )are markls'toX+ (tire <br /> septic system <br /> any:«f� ont'ius�for�nglease inclicate,is <br /> Wrier&:1 iis:informati in wasavailable atithetomelheevaluation was completed <br /> • The existing septic system consists of(check all that apply): <br /> Septic.Tank 0 Cesspool <br /> all prising lank <br /> Disposal Tranches/Leach lines <br /> liadtl-rormparnitnit Tank CAFFiagFlii <br /> Sebe Bad , Sand Filter <br /> Otter' <br /> o 0esapoola may l used only in seine eking sewageloa ds and;if4itin! only be roPllioPtimaitil <br /> a seepage pit system calls fiat are too iraOttaaccommodate a_srtaodar l ar other a ativc, <br /> onsite system. <br /> There is a permit for the septic system Wes ❑No DUnknnwp. <br /> PermitNusmber(s)..: . t <br /> Year original septic system installed: . (YYYY) ❑No record of installation data <br /> 40 Dates of subsequent repairs or alterations: %�1 J (YYYY) <br /> • All pbnmhxng.Soinres ate connected to the septic system . I?es ❑TTa ❑[Tnlmowr - <br /> If you answered No"or"unknown,"please describe below: <br /> • Additional cct9: <br /> 2. Overall Septic System States <br /> • Discharge of sewage to the ground surface DYes RNo[None observed <br /> • Dischargo of sewage to surface waters ❑Yea bio ❑None'observel' <br /> a. Sewage backup into pIu mbiug fixtures :Nes JNo ❑Unknown <br /> • Additional` : <br /> 3. Septic tank <br /> In order to folly describe the enacrttion elm tunic tim,septic'tnnkiriayneec:to'bepumped.Please <br /> iu irate <br /> belniing-‘qeptio,.aysterntankwasbelow puniped dining Ili.coupe of thin evaluation. <br /> ' Septic tank s pumped du ing,;the courseoftha evaluation XYcs ❑No <br /> it If the septic tank was pumped ctiuingthe course;of Mir tringuation, <br /> please'explain(e.g. <br /> septic x ixad. ser declined,to has the tank,pumped etc): <br /> Page 2118 <br />