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Oregon Department of Environmental Quality <br /> * The septic tank material is: <br /> l_x I Concrete <br /> r 1Steel <br /> Plastic <br /> Fiberglass <br /> i <br /> j Other(explain) <br /> L Unknown <br /> * Is the septic tank accessible? x :Yes No <br /> * Septic tank volume in gallons 1,000 <br /> * Tank volume determined by:Check all that apply,add comments below as needed <br /> T^1 Permit Records x ' Measured ! 'Stamped on Tank ' 'Other <br /> * Septic tank risers are at ground level Yes x ' No <br /> * Tank appears to be free from defects, leaking and signs of deterioration x 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 ' x Yes !No <br /> * Septic tank baffles are intact: Inlet ; x Yes No Outlet x Yes I No <br /> i <br /> * Baffle material Inlet x Plastic Concrete ' Metal <br /> Outlet i x ; Plastic Concrete Metal <br /> * Effluent filter is present Yes x No <br /> * Effluent filter is free of debris _ !Yes ' No x+Not applicable <br /> * Liquid level in tank relative to invert of outlet ; x At 1 Above L_Below <br /> If above or below invert outlet, please explain: <br /> * Scum layer 3 (inches) Sludge layer 4 (inches) <br /> * Scum and Sludge layer more than 35%of the total tank volume I Yes x I No <br /> Indicate where sludge measured from: _ Inlet ' Middle i x I Outlet <br /> * Additional comments: <br /> PERFORMED A 150 GALLON FLOW TEST WITH A FLOW METER. <br /> 4. Dosing tank/Pump Basin <br /> Dosing tanks use a pump to send effluent to a treatment unit or soil absorption field. <br /> * The septic system has a dosing tank 'Yes x '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 L No <br /> Page 3 of 8 <br />