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Oregon Department of Environmental Quality • Locate all drain lines in soil absorption system ®Yes No Total length of drain lines 70 (ft) Lengths determined by['Physically uncovering portions of system/probing❑Written records ❑Fish tape NElectronic locator e:tamera • Absorption area appears to be free from roads,vehicular traffic,structures,livestock, deep-rooted plants etc. pYes ❑No If you answered"No,"please describe below: -• Absorption area appears to be free from surface water runoff and down spouts , Yes ❑No • Evidence of ponding in absorption area or distribution unit(s) DYes ONo • The soil absorption system replacement area assigned in the permit record appears to be intact: Yes ❑No❑Replacement_area not identified in permit record If you answered"No,"please explain below: • Additional Comments: fr/2T rLe C> A re24).„ 3 0 A-'O 2 cL C, go . /j.YiN 4-6s dA-,-& /4.-r Gi2vw7N 47a,v7 vv4 A-",o 62o .friz6ore.v/ /'Ze7vied cr'.' 4c'rl'on Gv..)9i,..144,L, u,✓ /47761 _ IbtiKrvt),v.V l J72,f/+..+ u>2 /7�S A CL „9„, /7/7,41,9,Fie`Z Fy w-•0 /74F73 6 ,P T/N-�i Lr lr<t _ 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 tgiNo (If"No,"skip the rest of section 6) • Type of sand filter ❑ Intermittent ❑ Recirculating ❑ . Bottomless • Sand filter container appears free from defects,leaks and signs of deterioration: ['Yes ['No Page 5 of 8