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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> E. Steel <br /> El Plastic <br /> E Fiberglass <br /> • Other(explain) <br /> ✓ Unknown <br /> • Is the septic tank accessible? Wes. ❑No <br /> ., _�l tis'' -- <br /> • Septictank volume:m gallons i ( i <br /> a X'eo�)(:57) �` ? � <br /> • Tank volume determined by: Check all that apply,add comments belowas needed <br /> Permit.Records l / Measured❑Stamped on Tank❑Other s. f <br /> • Septic tank risers are at ground level ❑Yes �NoS�Q ri � i5 1Q <br /> • Tank appears to be free from defects,leaking and signs of deterioration l.1 Yes ❑No <br /> If you answered."No,"please describe thecondition of the septic tank below.For example, <br /> evidence of gas corrosion,cracks,leaks,etc. <br /> • U <br /> Septic tank lid(s)is intact r4 Yes ❑No <br /> • Septic tankbaffles are intact:Inlet. 4Yes ❑No Outlet ElYes ❑No <br /> • Baffle material-Inlet KPlastic Moncrete rMetal Outlet gPlastic Concrete [Metal <br /> Effluent filter is present ❑Yes gNo <br /> • Effluent filter is free of debris ['Yes ❑No , Not Applicable <br /> • Liquid level in tank relative to invert of outlet RAAt ❑Above ❑Below <br /> If above or below invert.outlet,please explain: <br /> • Scum layer 11 (inches) Sludgelayer la" .(inches) <br /> • Scum and Sludgelayer more than 35%of the total tank volume ❑Yes <br /> Indicate where sludge measured from:['Inlet_ ❑Middle -Outlet <br /> • Additional Comments: <br /> 4; Dosing tank/Pump.Basin. <br /> Dosing tanks use a pump to send effluent to a treatment unit or a soil absorption field. <br /> • The septic system has a dosing tank T Yes ❑No <br /> (If"No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was onto test the pump(s): ❑Yes (KNo <br /> Page 3 of 8 <br />