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` Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> 11. Concrete <br /> 11 Steel <br /> ❑ Plastic <br /> ❑ Fiberglass <br /> [7Other(explain) <br /> • Unknown <br /> • Is the septic tank accessible? JYes ❑No <br /> • Septic tank volume in gallons v g 2( .15(Vex_ 53 0ra 6p � <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> n Permit Records X.Measured❑ Stamped on Tank❑Other <br /> • Septic tank risers are at ground level ['Yes N[No uci-fG 1 � u v` .-ey <br /> ouitl <br /> • Tank appears to be free from defects,leaking andsigns of deterioration kes ❑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 ,4 Yes ❑No <br /> • Septic tank baffles are intact:Inlet &Yes ❑No Outlet Byes ['No <br /> • Baffle material-Inlet Wlastic Concrete ❑Metal Outlet Wlastic LiConcrete ❑Metal <br /> Effluent filter is present ❑Yes kNo <br /> • Effluent filter is free of debris ❑Yes ❑No jNot Applicable <br /> • ►� ['Above Liquid level in tank relative to invert of outlet ,� t ❑ bo ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 17 (inches) Sludge layer )7- (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes NC No = et 610 <br /> Indicate where sludge measured from: [Inlet ❑Middle ROutlet <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 kto <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 />