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Last modified
6/28/2019 8:43:57 AM
Creation date
6/20/2019 2:27:07 PM
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Permits
Permit Address
5925 STATE ST
Permit City
SALEM
Permit Number
555-19-003587-AUTH
Parcel Number
072W28C 02300
Permit Type
Authorization
Permit Doc Type
Permit Document
Status
Ready to Film
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A <br /> Oregon Department of Environmental Quality <br /> • Locate all drain lines in soil absorption system DYes ❑No <br /> Total length of drain lines (ft) <br /> Lengths determined by❑Physically uncovering portions of system/probing❑Written records <br /> ❑Fish tape[]Electronic locator❑camera <br /> • Absorption arca appears to be free from roads,vehicular traffic, structures,livestock, deep-rooted <br /> plants etc. <br /> DYes ONo <br /> If you answered"No,"please describe below: <br /> • Absorption area appears to be free from pp surface water runoff and down spouts DYes ONo <br /> • Evidence of ponding in absorption arca or distribution lunit(s) DYes ❑No <br /> • The soil absorption system replacement area assigned in the permit record appears to be intact <br /> DYes ONo(] 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 evesand filter system will <br /> contain all of the components mentioned below,e.g. pumps.The own of a sand filter system <br /> permitted on or after January 2,2014 must maintain an annual servi contract with a certified <br /> Maintenance Provider.Maintenance records should be available from t e system owner,or the <br /> contracted Maintenance Provider. Please attach copies of the previou two years of <br /> maintenance records to this evaluation form. <br /> • The septic system has a sand filter DYes No <br /> (If"No,"skip the rest of section 6) <br /> • Type of sand filter <br /> 0 Intermittent I <br /> ❑ Recirculating <br /> ❑ Bottomless <br /> 1 ss <br /> • Sand filter container appears free from defects, leaks and signs of deteri ration: DYes <br /> ONo <br /> Page 5 of 8 <br /> I <br />
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