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of Environmental Quality <br /> Department <br /> • The septic tank material is: <br /> Concrete <br /> 0 Steel <br /> O Plastic <br /> O Fiberglass. <br /> Other(explain). <br /> O' Unknown <br /> • Is:the septic tank accessible? [EYes ONo <br /> • Septic tank volume in gallons 11.O5 td x {(Sfi2) ofaG -S e°A tea) ZY1i S: <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> Q Permit Records.2 measured D Stamped on Tank O;.Other <br /> • Septic tank risers are at ground level ZYes ONo <br /> • Tank appears to be free:from defects,leaking and;signs of deterioration JYes ONo <br /> lf you.answered"No,"please describe the condition of the septic tank below.For example, <br /> evidence of gas corrosion,cracks,leaks,etc. <br /> `Tank c ier.+wp r ay.A, AA eke e i Le t r rode-,ea✓t <br /> • Septic tank lid(s)is intact jYes ONo <br /> • Septic tank battles are intact:Inlet. 21Yes° ONo Outlet [Yes ONo <br /> • Baffle material-Inlet re °lastic (Concrete [Metal Outlet VPlastic DConcrete EMetal <br /> Effluent filter is present OYes rZINo <br /> • Effluent filter is free of debris OYes ONo .gNot Applicable <br /> • Liquid level in tank relative to invert of outlet .ZAt DAbove OBelow <br /> If above or below invert outlet,please explain:, jV1 <br /> • Scum layer (inches) Sludge layer (inches). <br /> • Scum and Sludge layer more than 35%of the total tank volume OYes EZINo <br /> Indicate where sludge measured from:: Inlet OMiddle EgOutlet <br /> • Additional Comments: <br /> 4. Dosing tank/Pump Basin <br /> Dosing tanks use a pump to send effluent to atreatment unit or a soil absorption field. <br /> • The septic system has a dosing tank DYes ElNo <br /> (If"No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was on to test the puznp(s):.OYes ONo. <br /> Page 3 of 8 <br />