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• • Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> N Concrete <br /> • Steel <br /> • Plastic <br /> 0 Fiberglass <br /> ❑ Other(explain) <br /> ri Unknown <br /> • Is the septic tank accessible? r]Yes ❑No <br /> • Septic tank volume in gallons <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> Permit Records❑ Measured❑ Stamped on Tank❑ Other <br /> II <br /> • Septic tank risers are at ground level D4Yes ❑No <br /> • Tank appears to be free from defects, leaking and signs of deterioration ►'1 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 $Yes No <br /> • Septic tank baffles are intact: Inlet [, Yes No Outlet ryes ❑No <br /> • Baffle material -Inlet[Plastic ❑`Concrete EMetal Outlet igPlastic EConcrete {^Metal <br /> Effluent filter is present ❑Yes KI o <br /> • Effluent filter is free of debris ['Yes ❑No VINot Applicable <br /> • Liquid level in tank relative to invert of outlet [MAt ❑Above ❑Below <br /> If above‘or below invert outlet, please explain: <br /> • Scum layer 1 b (inches) Sludge layer 1.0 (inches) <br /> • Scum and Sludge layer more than 35%of the Iola/tank volume ❑Yes A No <br /> Indicate where sludge measured from: ❑Inlet ['Middle !J,4Outlet <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 ,v 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 ❑No <br /> Page 3 of 8 <br />