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Oregon Department of Environmental Quality <br /> g• septic tank material is: <br /> Concrete <br /> 0 Steel <br /> 0 Plastic <br /> 0 -Fiberglass <br /> 0 Other(explain) <br /> 0 unknown <br /> . Is the septic tank accessible? es ON° <br /> • Septic took volume in gallons (OD in <br /> din <br /> • Tank volume determined by: Check all that apply,add co cuts below as needed <br /> 0 Permit Records 0 Measured 0 Stepped on Tank Other <br /> • Septic tank risers are at ground level ibIllYes ON° <br /> • Tank appears to be free from defects,leaking and signs of deterioration[]Yes U‘o <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 /> ke'C-ftrouttpl:...II i <br /> i <br /> • Septic tank lid(s)is intact DIres Nod <br /> • Septic tank bafflesE <br /> are intact Inlet afes No Outlet OYes [:]No <br /> • Baffle material-Inlet OPlaptic concrete Ddetal Outlet Plastic OConerete DMetal <br /> • Effluent filter is present ISnYes ON° <br /> • Effluent filter is free of debris ElYes No :Not Applicable <br /> • Liquid level in tank relative to invert of outlet DAL DAbove elow <br /> If above or below invert outlet,please explain: <br /> • Sewn layer Ai I ,(inches) Sludge layer 1/ i (inches) <br /> • Scum and Sludge layer more than 35%of the total m i volume OYes ONo <br /> Indicate where sludge measured from Ellidet Diddle [(Outlet <br /> • Additional Comments: I <br /> lot^K evica.i.C 't d. ced- eJ v,11) <br /> 4. Dosing tank/Pump Basin <br /> Dosing tanks use a pump to send effluent to a tr--.: -nt unit or a soil absorption field. <br /> • • The septic system has a dosing tank EiYes No <br /> • Of'No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was on to test the pump(s): . Yes EINo <br /> Page 3 of 8 <br />