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Oregon Department of Environmental Quality }x <br /> • The septic tank material is: <br /> K. Concrete <br /> C Steel <br /> ® Plastic f <br /> ❑ Fiberglass <br /> f] Other(explain) <br /> r Unknown <br /> © Is the septic tank accessible? 1Yes ❑No <br /> e Septic tank volume in gallons 1 I 12-)c, ;,t � i '$- i ?cc:1(p) <br /> ® Tank volume determined by: Check all that apply,add comments below as needed <br /> ❑ Permit Records Measured❑ Stamped on Tank❑ Other <br /> ® Septic tank risers are at ground level ❑Yes ENo - 7�1 G-L.1/44--/ L t 4o' <br /> ® Tank appears to be free from defects, leaking and signs of deterioration la Yes ['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)is intact 1Yes ❑Noz5 B ( e-ov: F - edit.- <br /> 1/7 <br /> e Septic tank baffles are intact: Inlet EYes ❑No Outlet Yes ❑No <br /> e Baffle material-Inlet❑Plastic Mconcrete OMetal Outlet EPlastic KConcrete [IMetal <br /> Effluent filter is present ['Yes JNo <br /> ® Effluent filter is free of debris ['Yes ['No 4 Not Applicable <br /> ® Liquid level in tank relative to invert of outlet ❑At ❑Above 413elow • <br /> If above or below invert outlet,please explain: V y)eleito a'S <br /> ® Scum layer (0' (inches) Sludge layer 14,1.-- (inches) <br /> ® Scum and Sludge layer more than 35%of the total tank volume ,Z4 Yes ['No:: 51% <br /> Indicate where sludge measured from: ❑Inlet ['Middle 17 Outlet <br /> 0 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 ILINIo <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): ❑Yes [No <br /> Page 3 of 8 <br />