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r ' <br /> Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> 1 Concrete <br /> El Steel <br /> Plastic <br /> El Fiberglass <br /> In Other(explain) <br /> Unknown <br /> • Is the septic tank accessible? Wes ❑No <br /> • Septic tank volume in gallons I OOP <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> f f ermit Records❑Measured❑Stamped on Tank❑Other <br /> • <br /> • Septic tank risers are at ground level ®Yes ['No <br /> • Tank appears to be free from defects,leaking and signs of deterioration Dyes VONo <br /> If you answered"No,"please describe the condition of the septic tank below.For example, <br /> evidence of gas corrosion,cracks,leaks,etc. < I • • <br /> 0 p ljvh6�1i ‘FOt t\ef( t1(A I S 5 ��-� -D ake tcJbc, w , Pb tonJrr,\ '- <br /> • Septic tank lid(s)is intact 11Yes ❑No <br /> • Septic tank baffles are intact:Inlet ®Yes ❑No Outlet [Y]Yes ❑No <br /> • Baffle material-Inlet Plastic nconcrete OMetal Out_WgPlastic ❑Concrete OMetal <br /> Effluent filter is present Dyes V]No <br /> • Effluent filter is free of debris Dyes ❑No IINot Applicable <br /> • Liquid level in tank relative to invert of outlet [IAt ['Above ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer (inches) Sludge layer (inches) <br /> • Scum and Sludge layer more than 35% of the total tank volume Dyes 2:1 No <br /> Indicate where sludge measured from: ['Inlet ►1 Middle ['Outlet <br /> • Additional Comments: <br /> 4. Dosing tank/Pump Basin <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 VINo <br /> (If"No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was on to test the pump(s): Dyes ❑No <br /> Page 3 of 8 <br />