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Oregon Departmerrtx . i' n tal Quality <br /> • The'septic tank material is: <br /> Concrete <br /> '4 Steel <br /> MI Plastic <br /> :.. Fiberglass <br /> D Other(explain) <br /> E Unknown <br /> • is the septic tank accessible? DYes o <br /> - • Septic tank volume in gallons. <br /> • Tank volume determined by:Check all that apply,add comments below:as needed <br /> 0 Permit Records ES Measured 0 Stamped on Tank D Other <br /> • Septic tank risers are at ground level .QYes, 3�I o r 10 e-k <br /> • Tank appears`to be free from defects,leaking and signs of deterioration❑Yes I o <br /> Ifyou answered"No,"please describe the condiitiot of the septic tank below,,For,example, <br /> evide <br /> o gas corrosion,cracks,leaks,etc: <br /> c ��pj ( ' <br /> • Septiccx <br /> tdnk'lid(s).is intact fikes ONo <br /> • Septic-tank-baffle s are intact:Inlet-.,�1 Yes ONo Outlet Ores DNo <br /> • Ba$le material-Inlet ElPlastic raConcrete r! etal;Outlet OPlastic OConcrete TAiletal <br /> Effluent filter is present [Yes ISNo <br /> • Effluent filter is free of debris DYes ONo `�. of Applicable <br /> • Liquid level in tank relative to invert of outlet. DAt,DAbove (Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer <br /> . 0 inches Sludge la er inches <br /> • Scam and Sludge layer more than 35%of the total tank volume DYes ViNo <br /> Indicate where sludge measured from:Kidd t DOutlet <br /> • Additional Co' <br /> mmeztts: <br /> 4 4. Dosing tank f Fwnp Bashi <br /> Dosing:tanks use;a pump to'send`ef uent:to a treatment-unit or a soil absoiptit tt"field:, <br /> • The septic system has a dosing.tank E]Yes o <br /> F =. <br /> (If`No,"skip the rest of section 4) <br /> '• At the time of this evaluation the power was`on to test"the pnrip(s)::Nes o <br /> Page 3 of 8 <br />