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Oregon Department of Environmental Quality <br /> 0K.44f) ?/toll-ho/%ip iv ° re? be_ pcsstef' <br /> -Tin,! /Vf,2cavel ee 61-10a.,44,,w,az... . <br /> • The septic tank material is: <br /> E. Concrete: <br /> El Steel <br /> . .. . 0 Plastic <br /> El Fiberglass <br /> : El Other(explain) . <br /> fl Unknown <br /> • Is the septic tank accessible?.:glYes ONo <br /> • Septic tank volume in gallons froiD <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> 74:.' Permit Records Measured 0 Stamped on Tank 0 Other <br /> • Septic tank risers are at ground level OYes giNo <br /> .: ..: Tank appears to be free from:defects,leaking and signs of deterioration Dyes :gtNo <br /> If you answered"No,"please:describe.the:condition of the septic tank below.For example, <br /> evidence o f gas corrosion,c acks,leaks,etc. • <br /> • Septic tank lids)is:intact Wes ONo <br /> •.i Septic tank baffles are intact Inlet EYes ONo Outlet l Yes :DNo <br /> • Baffle material-Inlet lit: 'lastic . Concrete ::Metal Outlet FZPlastic OConcrete OMetal <br /> Effluent filter is presen(DYes :jg,N o <br /> • Effluent filter is free of debris DYes. DNo [ Tot Applicable <br /> • Liquid level in tank relative to invert of outlet DAt DAbove E4Below <br /> If above or berm-VT-weft outlet,please explain: <br /> • Scum layer eir . (inches)'.: Sludge layer , (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume DYes ElNo. <br /> . Indicate where:sludge measured from Dlnlet Rt.:Middle DOutlet <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 DYes "2No <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): []Yes DNo <br /> Page 3 of 8 <br />