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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> ® Concrete <br /> Steel <br /> • Plastic <br /> Fiberglass <br /> ® Other(explain) <br /> ® Unknown <br /> • Is the septic tank accessible? ZYes ❑No <br /> • Septic tank volume in gallons 1000 <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> ❑Permit Records ®Measured® Stamped on Tank❑Other <br /> • Septic tank risers are at ground level ❑Yes IZNo <br /> • Tank appears to be free from defects, leaking and signs of deterioration ZYes ❑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 ZYes ❑No Outlet ZlYes ❑No <br /> • Baffle material-Inlet 1ZPlastic Concrete CMetal Outlet OPlastic ❑Concrete OMetal <br /> Effluent filter is present ❑Yes ®No <br /> • Effluent filter is free of debris ❑Yes ❑No IZINot Applicable <br /> • Liquid level in tank relative to invert of outlet IZAt Above Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 2 (inches) Sludge layer6 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes ZNo <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 IZINo <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 />