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Oregon Department of Environmental Quality * Locate all drain lines in soil absorption system x Yes No Total length of drain lines that were able to be located 262 (ft) Lengths determined by x Physically uncovering portions of system/probing Written records Fish tape x Electronic locator x camera * Absorption area appears to be free from roads,vehicular traffic,structures,livestock,deep-rooted plants etc. Yes x No If you answered "No," please describe below: THE DRAIN FIELD LINE GOES THROUGH TREE AND BUSH AREA. * Absorption area appears to be free from surface water runoff and down spouts x Yes No * Evidence of ponding in absorption area or distribution unit(s) Yes x No * The soil absorption system replacement area assigned in the permit record appears to be intact: Yes x No Replacement area not identified in permit record If you answered "No," please explain below: THERE IS NO REPLACEMENT ARE THAT IS IDENTIFIED IN THE RECORDS. * Additional Comments: DISTRIBUTION BOX IS DETERIORATING,RECOMMEND REPLACING THE DISTRIBUTION BOX. 6. Sand Filter System There are different sand filter system designs used in Oregon.Not every sand filter system will contain all of the components mentioned below,e.g.pumps. The owner of a sand filter system permitted on or after January 2,2014 must maintain an annual service contract with a certified Maintenance Provider. Maintenance records should be available from the system owner,or the contracted Maintenance Provider.Please attach copies of the previous two years of maintenance records to this evaluation form. * The septic system has a sand filter Yes x No (If"No,"skip the rest of section 6) * Type of sand filter Intermittent Re-circulating Bottomless * Sand filter container appears free from defects,leaks and signs of deterioration: Yes No Page 5 of 8