11996119 - Laserfiche WebLink

Home Browse Search

. ,• - -- - .. : .. .. • - .. . . ... .. . . . . . ... . . .: ::- •• •. . . . -;' ::: :::...::' ' •• :' • . :* - :. " - :: :: ': ' :: • . : ••. . : .... . :" ::." • :.:' •. .:: '• • .7: :• :.' :: i - -: :' :: ' i: . : ... ••. - .:: ii :: -: . :: • . - '.'Oregon Department ot Environmental Quality .: :: :: :. :! :i :: . -• •••• - - ••. .• •• - •. •. . .. .. •- • : • • . . . :: • F.-. .• .,• • ,•: .• .,: :• ::: E:. :, : :: i: . :i ... i i: •.. . •- -.. ..• - : : : Ii General System InforMation • -. . . • .. . . . •; :: i:; .E. The Existing SysteinEValuation Report form contains 8 pagea).Some of the questions on this • : .: :• •: :.:•:•:: :: fOrminay:not pertain to the system being evaluated,as there many system design's.If you.:(the .. -: • :•::: •• •.: :• septic system evaluator)are unable to answer any of the ..questions on this form please indicate,in •: .: ., .:- •: .:- •:- " . :. :. .: ..: EE • writing,why this information was not•available.at the time the evaluation was completed. • •. . . ••. :. :i ::' : ': •: - - •• :- - : : : -.. ..: .. :.: ..:, The existing septic system consists of(cheek all that apply): . • •. •• • : : • . , , • . • :Septic Tank !:' .,.. :• , ., !; •..0::- Cesspool • : . - • • • . . ... .. . . . .. . . .. . . . . ••• - ••••• Dosing Tank :: ::: .: • : lii:i Disposal Trenches!Leach Lines . :...: .; .:,...-; . :. - ••• • •• - Multi-compartment Tank ; •i '0':.: Capping Fill: . . • • • . :: • • •:-. 0 Seepage Bed : ': :i •' ;0 i' Sand Filter 1 .. • •• ••- •. : • .. .. : •:: •.: ;i:. • 0 -Other •::. ;:: :. ': :' • :i :. ,E. .. . : • . . . • • •• :-: •:: •::"" "• .. .. : :• ..: •: Note Cesspools May be used only to serve existing sewage loads and if failing only be replaced with • • • "":. •.:i iE.:.: aSeepagepit system on lotS that are too small to accommodate a standard system or other alternative • . , ' :•;! ::i ::',:.'::: onsite sY .ern.;.:• :::: !iE !:E :! 7: i il •:* ::' iir:; . , . : :: . • There is aPerinit for the septic system Wei Olio [JUnknown . :. . . • . : : .• .• • . . . . .. :.: '..:,•E.. • Permit Number(s)s..:.0 —o3/, :. . . • •-..: ::: : : • ••. ..• •• . • Year Original septic system installed: :::2 Ci5c7, E.(Y-YtY)11 1 Olio record of installation date • • • i'.: :: :.::..,i •• Dates of subsequent repairs or alterations: : — (YYYY)i. . . .. . . '. : :: •.: •• .. . . . .. !: All plumbing fixtures are connected tOheseptic system. Oyes .123No DIJiilmoWn . .. . • ... ... .. ... .. If you answered"NO"or" own,"please describe belowi.! • •. . . . . . ..: .• : ::- ::!: ; i: ':; ;:• :i P€9 .7z-j::F/!./N i: ii-v.e.45 __. ..-‘,‘(7ipt? :• ii ii • • .• :. . . ..• :: . : . • : .. . • •. . .. •. .. . .- •:: :: :: :: ::• : :.: :.• . . .. : :. • :- : :: •• • . • — . • •. . . . . . . - • • - • :i E.: . • • .-• . ::,i : :-i •• Additional Comments:: ' : :: :i :: Ei :: • •• • -- : • • :. :: •• :: :: .• :.• :: : • • - •:- : •:, •: •• :- ::. : : ,: :: :: :: :: :: :: :: . .. . • : . :: :,; ...•-. s.. :: ::. :: !: ,i: .: : :: .: :; : .. • •• - .. . . . • - : .. •: • • • • •. .. . • . . .. . .. . . . . . :. :•••: li ::::': .. .. . •• . . . . :. .• • i.•• :. • •• - - , ., .. - •. .. . • -• - .'• :•• :::' 1 Civerall Septic SyiteniStatis .. .. •.. • .. • ..E r: • ::::i :: : .-• ::• • -. -: .: . . i• :: • - . . • - • .•• : •:-. Discharge of sewage to the ground surface DYes No None observed . .• • : • :::: : : : :: :: • •• .• ::* :: E. ;: •!. Discharge of sewage to surface waters: []Yes Iasi° []None observed : ii i: -: : ••, . . . ... • ... - • ••••• ': :; :: :.•Ei • Sewage backup into plumbing fixtures- : Yes::ElVo Ettfnktown •: i, .: ::: : . ::-: •.. - :. :• -. • - .- .: -. ..... .• :: . . - . .: :. . .. . . . :-: :: . :r• ii- Additional Coinments: i :, .. .. ..• .::::.:- : .•• :: .-. . • . •• . . ::: •: •. ::. : .• •: :.: .. :•: ::: • :: • :.• .• . . . •• :::.: : .: :. : : : .: •: • : -. .:. . :: ••• • :: . .-• .• ' , • ,• :. :: :. : •.. • • :- : • :: . - ::: :: : ... .• . :. ... •: .: ,. :. ::::. .. .• • . : - - • .• .: ::: : • ::. :: .: :.: .. . •: . .., .. :. :: • ,,,i, , • • -.. . . ., ,. • .. ::: :; :: : :•• i:: ::. - ;1; ::. : .: ..- :: :, :: i• ::::: , •• •si• : 3.. $'eptiC tanc ' ! ' ' ". .: ' . ., ,. . .. ,.. ••: -.:. ::::: .:: ..• :-. -• - •- :. . . .• •. .. .. - •. . :: ,: • ...: k :.:El• :i '': In order to fully describe the condition of the tank,the septic tankmay need to be pUmped.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.WY-es ONo . •. . : . •.: ::. ::: ::: • :,. •: :•: :: ::: ::. ,:- :: • . .:: :,- :: -.• : •• If the septic tank was NOT pumped during the course of thLs evaluation,please explain(e.g.. •• . . . ':: ::. •:: :: : •:- septic system owner declined to have the tank pumped etc) •• • : .• . : • !:::: : ..• . . . • .. . . . . .. . .•. .• . . . . . . . .. ... . .. . . .... . . •• - •• •• .. . . . • .i -. •.• : : -:: :. - .• -. :: - •Page 2 of 8 .: '.::: - : . • : . .. :: • :: :: . .: -:: • • • • . : .•:: .. . . . • . ..: .... ::: .: •. ::: ::: .: ::: ::. • • .. • . ••. :•: ::• :• : : .:: :: :• ::: . •: :. •: . .: • .: :. ::: : • . • .. . . . .. . : . .. .• . ... ... .. . ... .. . . ... . . . . : :•:• : . . . ... ... . . .. . . . .. •. - . .. .• - • .. .. . . . . .