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'Nr1/4- <br /> r1016 <br /> Dragon Department of Environmental Quality <br /> • The septic tank material is: <br /> SWeI• C°11cre1;° <br /> . aplastic <br /> 10 Fiberglass <br /> E3 Other(explain) <br /> El Unknown <br /> * Is the septic tank accessible? ZYea [JNo <br /> a Septic tank volume in gallons 4 eso , <br /> • Tank volume determined by:Check all that apply,acid am:meats below as needed <br /> 1PerithtRecords prIVfrastred 12 Stamped on Tank Other <br /> • Septic tank risers are at grotind level Fens ['No <br /> • Tank appears to be ftee from defects,leeldre and signs of d.eteriondiontlrYes ON° <br /> If you answered"No,"please describe the collation piths septic tank bekm.For example, <br /> evidence of gas corrosion,cracks,leaks,etc. <br /> TooK. alSemk <br /> * Septic tank lid(s)is intact VIII ONO <br /> • Septic tank baffles are intact Inlet 2iTy. EINb Outlet ['Yes DNo <br /> • Baffle material-Wallas& MConcrete [Natal Outlet Dlestic teConcrete EP/fetal <br /> =neat tilts is present Dires No <br /> • • Effluent filter is free of debris DYes ONe 126Not Applicable <br /> * Liquid level in tank relative to invert of outlet IXIA1 tJAbove OBelow <br /> If above or below invert outlet,please explain: , <br /> • Scam layer (inches) Sludge layer (inhes) <br /> • Scum and Sludge layer more than 35%of the total tank volume DYes, No <br /> • Indicate where sludge measured from:Olnlat Deliddie ['Outlet <br /> o. .Additional Commeuti: <br /> 'OM / A • <br /> 4. Dosing tank/Pump Basin <br /> Dosing tanks use a pump to send effluent In ailment unit or ascii absorption field: <br /> • The segfic system has a dosing talk DYes Pallo <br /> (If"No,"skip the rest of sectinn 4) <br /> • At the time of this evaluation the power was on to test the pump(s):DYes []Na <br /> Page 3 of 8 <br />