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,a • Oregon Department of Environmental Quality • O IP V1 Cr a_CcI:it,e ._ lie) ce;Ld->d- of o•-P itaely k Gr. Loa T IeL/6r •. The tic tank material is: Concrete ❑ Steel ri Plastic ❑ Fiberglass E Other(explain) D Unknown • Is the septic tank accessible? Yes ❑No • Septic tank volume in gallons it 000 • T olume determined by: Check all t"at apply,add comments below as needed Permit Records CIMeasured Stamped on Tank❑ Other • Septic tank risers are at ground level ❑Yes ❑No • Tank appears to be free from defects,leaking and signs of deterioration❑Yes jo If you answered"No,"please describe the condition of the septic tank below.For example, evidence of gas corrosion,cracks,leaks,etc. belt C or,-os e del ex boo c t c%4-e✓- /To) & Tke'u/- G9 A I a jj e 8,01& 1 lit. 4o o c/&r ours 'i•-/- . Co 1i r c C libtfreA7iIS • Septic tank hd(s)is intact ❑Yes o -f"u✓4 b ee:045• • Septic tank baffles are intac •Inlet lees ❑No OutletYes ❑No • Baffle material-Inlet lastic QCon .ete OMetal Outlet ‹tic OConcrete ❑Metal Effluent filter is present ❑Yes No • Effluent filter is free of debris ❑Yes ❑No Not pplicable • Liquid level in tank relative to invert of outlet At "❑Above ['Below If above or below invert outlet,please explain: • Scum layer (inches) Sludge layer (inches) A)01- 1°0'44'4't.', _ L • Scum and Sludge layer more than 35%of the total tank volume ['Yes ❑No a, -i-A._$ Indicate where sludge measured from: ❑Inlet ❑Middle [Outlet -I- , e • Additional Comments: 4. Dosing tank/Pump Basin Dosing tanks use a pump to send effluent to a treatme unit or a soil absorption field. • The septic system has a dosing tank [Yes [ oo (If"No,"skip the rest of section 4) • At the time of this evaluation the power was on to test the pump(s): [ e o Page 3 of 8