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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 /> • The septic tank material is: • " • • <br /> — -• • <br /> . . • <br /> • • • •• •• • • <br /> !! ELI <br /> Concrete <br /> Steel <br /> Plastic ;;; <br /> . . <br /> Fiberglass i!i . .•: : <br /> . • • . <br /> • <br /> fl Other(explain) !!! !! !! <br /> fl Unknown !!! • <br /> !! 11 !! <br /> • Is the septic tank accessible? II'',Yes ONO 11 • <br /> . . <br /> !! !! <br /> • Septic tank volume in gallons/ .il:ID <br /> . . . <br /> . . . <br /> • Tardc;volume determined by Check all that apply,add comments below as needed <br /> In Permit Records I Measured 0 Stamped on Tank 0 Other . . <br /> • <br /> • Septic tank risers are af!ground level !Wes DN0 !!!!! <br /> -; •• • .• ••• ••• •-• • -• ••• •• •• • •; • <br /> • Tank appears to be free from defects,leaking and signs of deterioration 0Yes 2No <br /> !; • !; !! !: ::::!! ! <br /> If you answered"No,"please describe the Condition of the septic tank below.For example, <br /> • • •-• --; •-• • •-• <br /> evidence of gas corrosion,cracks, etc. ;; ;;;;; • <br /> P2 if <br /> • " <br /> !!‘-, ' 4 rbe' <br /> ! i; ;;• • Sepik tank lid(s)is intact ['Yea { No <br /> • Septic tank baffles are intact:Inlet rigYes i 0No Outlet NYes 0No <br /> • Baffle material-Inlet rikPlaStic Concrete ;17Metal Outlet rPlastic FlConcrete DMetal <br /> Effluent filter is present Olres [ No <br /> :• ,; : <br /> • Effluent filter is free of debris []Yes0No kl Not Applicable • • <br /> • Liquid level in tank relative to invert of outlet At ElAliOve OBelow <br /> If above or below invert outlet,please explain: • • <br /> . . <br /> Scum layer /1i (inches) Sludge layer 2/1/ (inclies) <br /> . . . . <br /> • Scum and Sludge layer more than 35%of the total ['Yes NINo <br /> Indicate where sludge measured from!!Olnleti- ['Middle gslOutlet . . <br /> . . <br /> . . . <br /> • Additional Comments: :::; <br /> . . . <br /> . . . . ,• <br /> . . . . . <br /> 4. Dosing tank/,Pu#),p Basin : <br /> • <br /> Dosing tanks use apuitip to send effluent to a treatment unit or a soil absorption field <br /> • The septic system has a dosing tank DY.'.es <br /> . . <br /> (If"No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was onto test the pump(s): ['Yes Ell\To <br /> : •. <br /> • . . . <br /> . . <br /> . . . <br /> Page 3 of 8 !! <br /> . . <br /> . . . . . <br /> . . . . <br /> . . . <br /> . .. . <br /> •• ••• •• • •• <br />