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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> O Steel <br /> Plastic <br /> 11 Fiberglass <br /> • Other(explain) <br /> O Unknown <br /> • Is the septic tank accessible? XYes ONo <br /> • Septic tank volume in gallons 1,0(73 <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> O Permit Records O Measured O Stamped on Tank Other <br /> • Septic tank risers are at ground level Wes ONo <br /> • Tank appears to be free from defects, leaking and signs of deterioration AYes ONo <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 NYes ONo <br /> • Septic tank baffles are intact: Inlet Q.Yes ONo Outlet jYes ONo <br /> • Baffle material-Inlet MPlastic DConcrete ]Metal Outlet K'lastic [Concrete' OMetal <br /> Effluent filter is present ❑Yes y,No <br /> • Effluent filter is free of debris Oyes [No NieNot Applicable <br /> • Liquid level in tank relative to invert of outlet ❑Above Below <br /> If above or below invert outlet, please explain: <br /> • Scum layer (inches) Sludge layer t 2 (inches) <br /> • Scum and Sludge layer more than 35% of the total tank volume ❑Yes IXNo <br /> Indicate where sludge measured from: [,(Inlet [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 'No <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 ONo <br /> Page 3 of 8 <br />