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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> tConcrete <br /> Steel <br /> • Plastic <br /> O Fiberglass <br /> Q Other(explain) <br /> J Unknown <br /> • Is the septic tank accessible? ❑Yes ,'; o <br /> • Septic tank volume in gallons .l6 . <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> i7.1 Permit Records❑Measured❑ Stamped on Tank❑ Other <br /> • Septic tank risers are at ground level ❑Yes $No ) Jr 'Sje$ p.„) <br /> • Tank appears to be free from defects, leaking and signs of deterioration Ives ❑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)iis intact Wes ❑No <br /> • Septic tank baffles are intact:Inlet ❑Yes giklo Outlet Yes ❑No <br /> • Baffle material-Inlet plastic UConcrete AMetal Outlet!da'lastic DConcrete ❑Metal <br /> Effluent filter is present ❑Yes ZNo <br /> • Effluent filter is free of debris [Yes ❑No ANot Applicable <br /> • Liquid level in tank relative to invert of outlet pa ❑Above ❑Below <br /> If above or below invert outlet, please explain:_ <br /> • Scum layer (inches) ' Sludge layer 6 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes io <br /> Indicate where sludge measured from: ❑Inlet ❑Middle goutlet <br /> • Additional Csommgnts "eys'v <br /> ,__ a t://1)± A-Alie. <br /> 4. Dosing tank/Pump Basin it'e—` '- <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 ❑Yes <br /> (If"No,"skip the rest of section 4) Xlio <br /> • At the time of this evaluation the power was on to test the pump(s):❑Yes ❑No <br /> Page 3 of 8 <br />