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Oregon Department of Environmental Quality <br /> did not pump now;scheduled pumping for later date <br /> • The septic tank material is: <br /> Concrete <br /> Ej Steel <br /> Plastic <br /> El Fiberglass <br /> Other(explain) <br /> €❑ Unknown <br /> • Is the septic tank accessible? ®Yes ❑No <br /> • Septic tank volume in gallonsJ5)/0.c90 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit Records ig3 Measured❑Stamped on Tank❑Other <br /> • Septic tank risers are at ground level [...]Yes No <br /> • Tank appears to be free from defects,leaking and signs of deterioration®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 /> water is below outlet <br /> • Septic tank lid(s)is intact ®Yes ❑No <br /> • Septic tank baffles are intact:Inlet, [IYes [No Outlet 1Yes ❑No <br /> • Baffle material. Inlet Plastic Woncrete ❑Metal Outlet ri.Plastic ZCoricrete ❑Metal <br /> Effluent filter is present ❑Yes IZNo <br /> • Effluent filter is free of debris ❑Yes ❑No ZNot Applicable <br /> • Liquid level in tank relative to invert of outlet ❑At ['Above ®Below <br /> If above or below invert outlet,please explain: System has been vacant for 2+years <br /> • Scum layer 0 (inches) Sludge layer (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes ®No <br /> Indicate where sludge measured from:.❑Inlet ®Middle ['Outlet <br /> • Additional Comments: <br /> Baffles are intact,no solids in tank <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 ®No <br /> (If"No,"skip the rest of section 4) N/A <br /> • At the time of this evaluation the power was onto test the pump(s):❑Yes DNo <br /> Page 3 of 8 <br />