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• <br /> Oregon Department of Environmental Quality <br /> • <br /> • The septic tank material is: <br /> P►�< • Concrete <br /> Steel <br /> ® Plastic • <br /> ® Fiberglass <br /> ❑ Other(explain) <br /> Unknown <br /> • Is the septic tank accessible? DYes MNo <br /> • Septic tank volume in gallons 10 C <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit Records❑Measured❑ Stamped on Tank nOther 'f k 1/k. -5r 4-14K-3 <br /> • Septic tank risers are at ground level DYes NINo k� Ij Ltd.3 <br /> • . Tank appears to be free from defects,leaking and signs of deterioration JYes ❑No <br /> If you answered"No,"please describe the condition of the septic tank below.For example, <br /> evidence of gas corrosion,cracks,leaks,etc. <br /> • Septic tank lid(s)is intact TYes.❑No <br /> • Septic tank baffles are intact:Inlet j,Yes ❑No Outlet 11 es ❑No <br /> • Baffle material-Inlet ` !i'lastic QConcrete �►l etal Outlet❑Plastic OConcrete Rivietal <br /> Effluent filter is present DYes �No <br /> • Effluent filter is free of debris DYes. ❑No igNot Applicable <br /> • Liquid level in tank relative to invert of outlet gAt DAbove DBelow <br /> If above or below invert outlet,please explain: <br /> • Scum layer 6 (inches) Sludge layer q (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume DYes • ONo <br /> Indicate where sludge measured from: ['Inlet gyiddle ['Outlet <br /> • Additional Comments: 0 <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 DYes I:l o <br /> (If"No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was on to test the pump(s): DYes ❑No <br /> Page3of8 <br />