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Oregon Department of Environmental Quality <br /> • Locate all drain lines in soil absorption system ®Yes ❑No <br /> Total length of drain lines 180 (ft) <br /> Lengths determined by ZPhysically uncovering portions of system/probing❑Written records <br /> ❑Fish tape lElectronic locator camera <br /> • Absorption area appears to be free from roads,vehicular traffic,structures,livestock,deep-rooted <br /> plants etc. <br /> Yes ❑No <br /> If you answered"No,"please describe below: <br /> • Absorption area appears to be free from surface water runoff and down spouts ®Yes ❑No <br /> • Evidence of ponding in absorption area or distribution unit(s) EYes IZINo <br /> • The soil absorption system replacement area assigned in the permit record appears to be intact: <br /> ❑Yes ❑No®Replacement area not identified in permit record <br /> If you answered"No,"please explain below: <br /> • Additional Comments: <br /> 6. Sand Filter System <br /> There are different sand filter system designs used in Oregon.Not every sand filter system will <br /> contain all of the components mentioned below,e.g.pumps.The owner of a sand filter system <br /> permitted on or after January 2,2014 must maintain an annual service contract with a certified <br /> Maintenance Provider.Maintenance records should be available from the system owner,or the <br /> contracted Maintenance Provider.Please attach copies of the previous two years of <br /> maintenance records to this evaluation form. <br /> • The septic system has a sand filter DYes INo <br /> (If"No,"skip the rest of section 6) <br /> • Type of sand filter <br /> ❑ Intermittent <br /> ❑ Recirculating <br /> ❑ Bottomless <br /> • Sand filter container appears free from defects,leaks and signs of deterioration: ❑Yes ❑No <br /> Page 5 of 8 <br />