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Oregon.Department of Environmental Quality <br /> • The septic tank material is: <br /> EConcrete <br /> Steel. <br /> E] Plastic <br /> 0 Fiberglass <br /> Other(explain) <br /> 0 Unknown <br /> • Is the septic tank accessible? gYes 0No <br /> • Septic tank volume in gallons\,OV--) <br /> • Tank volume determined by Check all that apply,add commentsbelow as needed <br /> ermit Records 0 Measured E Stamped on Tank 0 Other <br /> • Septic tank risers are at ground level [ es ONO <br /> • Tank appears lobe free from defects,leaking and signs of deteriorationZY-es 0No <br /> If you answered"No,"please describe the condition of the septic tank below For example, <br /> evidence of gas cpaosion,cracks,leaks,etc. <br /> • Septic tank lid(s)is intact JZIYes 0No <br /> • Septic tank baffles are intact:Inlet Wes 0No Outlet ['Yea 1:1140 <br /> • Baffle material.-Inlet Z4I1 •lastic MConcrete EMetal Outlet rPlastic DConcrete ElMetal <br /> Effluent filter is present 0-Yes 0No <br /> • Effluent filteris freeof debris 0Yes EINo ONotApplicable <br /> • Liquid level in tankrelative to invert of outlet KAt 0Above 0l3elow <br /> If above or below invert outlet,please explain <br /> • Scum layer 1, —7;e(inches) Sludge layer, nches) <br /> AB Scum and Sludge layer more than 35%of the total tank volume DYes IfNo <br /> Indicatewhere sludge Measured from:pnlet nMiddle 0Outlet <br /> -4 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 0Yes 0No 0 .1 <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):0-Ires 0No <br /> Page 3 of 8 <br />