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. . . . <br /> • . <br /> • <br /> . . <br /> : • • <br /> . . . <br /> Oregon Department of Environmental Quality <br /> . . <br /> • <br /> • •.• •:• . . . . . <br /> •• •.• •.• <br /> . — • <br /> • <br /> . . . . <br /> . . . <br /> . . . . <br /> . . . <br /> •.. • . . <br /> i: •j The septic tank Material is <br /> Concrete <br /> • <br /> i! ! ! Steel :; ;: • <br /> EJ Plastic <br /> • Fibflerglass <br /> Other <br />• lc] Other(exPlain) <br /> Unknown <br /> • Is the septic tank accessible? [ Yes ONO <br /> !! !! 4! Septic tank volume in gallons 2 <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> 0 Permit Records Measured El Stamped on Tank 0 Other <br /> • Septic tank risers are at ground level ElYes No <br /> • Tank;appears to be free from defects,leaking and signs of deterioration ra.Yes ::0No <br /> • •• • • • <br /> • • • <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 /> , •• •• <br /> . . . . <br /> . . „. . . <br /> . . . :• <br /> . " • •• <br /> • <br /> . . . . • <br /> • Septic tank lid(s) intact 0YeS No <br /> • <br /> • Septic tank baffles are intact Inle 0Yes! VANo Outlet a Yes 0No <br /> . „ <br /> !! ! • Baffle material-Inlet Plastic 4Concrete !DMetal Outlet riPlastic ECOncrete OMetal <br /> !! : <br /> Effluent filter is present 0)(es No <br /> . . • Effluent filter is free of debris []Yes 0No Not Applicable <br /> • Liquid level in tank relative to invert of outlet ri0 At DAbove 0Below . <br /> If <br /> above or below invert outlet,please explain: <br /> . . . . . . . . <br /> • Scum layer !!! !! (inches) !! Sludge layer (inches) <br /> . . <br /> • Scum and Sludge layer more than 35%of the total tank volume 0Yes No !! <br /> Indicate where sludge measured fromU ['Inlet! DMidclle L Outlet <br /> . . . . . <br /> !! : • Additional Comments <br /> !M! • <br /> • <br /> • <br /> .. : <br /> : ••- ••• -• <br /> 4. Dosing tank 1:rump Basin <br /> . . . : • <br /> • • <br /> . . <br /> I I <br /> Dosing tanks use a pump to send effluent to a treatment umt or a soil absorption field. <br /> ;! ! • The septic system has a dosing tank DY.es IgNo <br /> . . . . <br /> (If"No":skip:the rest of section 4) •• :! <br /> . . . . . . . <br /> : !! • At the time of tins evaluation the power was on to test the pump(s): 0Yes 0No <br /> . . . . . . • <br /> H !: :,! Page 3. of 1.) !'!! • • <br /> . . <br /> . . . . . . <br /> . . . . . <br /> . . . : <br /> . . . . <br /> . . . . . . . . . <br /> • " " " " " • <br /> . . . . <br /> . . . • <br /> . . . <br />