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Oregon Department of Environmental Quality Septic tank was pumped 2 years prior, customer did not want it pumped. • The septic tank material is: k Concrete Ei Steel Plastic Fiberglass n Other(explain) • Unknown • Is the septic tank accessible? ©Yes ❑No • Septic tank volume in gallons 1000 • Tank volume determined by: Check all that apply,add comments below as needed . ❑Permit Records©Measured❑ 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 ❑No If you answered"No,"please describe the condition of the septic tank below. For example, evidence of gas corrosion,cracks,leaks, etc. The septic tank was at operating level and i saw no signs of leaking. Did not pump tank so not 100% sure of condition of inside of the tank. • Septic tank lid(s) is intact ❑✓Yes ❑No • Septic tank baffles are intact: Inlet ®Yes ❑No Outlet (Yes ❑No • Baffle material-Inlet❑'Plastic [:Concrete WMetal Outlet Plastic Concrete nMetal Effluent filter is present ❑Yes ONo • Effluent filter is free of debris Oyes ENo Not Applicable • Liquid level in tank relative to invert of outlet At ❑Above ❑Below If above or below invert outlet,please explain: • Scum layer 3 (inches) Sludge layer 4 (inches) • Scum and Sludge layer more than 35%of the total tank volume ❑Yes No Indicate where sludge measured from: ['Inlet ❑Middle ❑✓ Outlet • Additional Comments: Septic tank lid is 12" below the surface. 4. Dosing tank/Pump Basin Dosing tanks use a pump to send effluent to a treatment unit or a soil absorption field. • The septic system has a dosing tank ❑Yes ❑✓No (If"No," skip the rest of section 4) • At the time of this evaluation the power was on to test the pump(s): ['Yes ❑No Page 3 of 8