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Oregon Department of Environmental Quality <br /> Tiva wag ten/Y40764- <br /> • The septic tank material is: <br /> Concrete <br /> El Steel <br /> • Plastic <br /> E] Fiberglass <br /> Other(explain) <br /> El Unknown <br /> • Is the septic tank accessible? es No <br /> • Septic tank volume in gallons 100 #5700 Garhigo <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> Permit Records Measured El Stamped on Tank❑Other <br /> • Septic tank risers are at ground level 26s ONo <br /> • Tank appears to be free from defects,leaking and signs of deterioration 12fes ❑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 [v]Ies ❑No <br /> • Septic tank baffles are intact:Inlets ❑No Outlet ErYes ❑No <br /> • Baffle material-Inlet MPlastic nConcrete pMetal Outlet Me<astic ❑Concrete OMetal <br /> Effluent filter is present [ es ❑No <br /> • Effluent filter is free of debris Fees ❑No ENot Applicable <br /> • Liquid level in tank relative to invert of outlet ❑At [(Above ❑Below �JY4 <br /> If above or below invert outlet,please explain: <br /> • Scum layer (inches) Sludge layer (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes [No <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 [ 'es ❑No <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): es ❑No <br /> Page3of8 <br />