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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> E Concrete <br /> ❑ Steel <br /> ❑ Plastic <br /> ❑ Fiberglass <br /> ri Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible? ®Yes ❑No <br /> • Septic tank volume in gallons 1,000 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> l Permit Records®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 /> • Septic tank lid(s)is intact ®Yes ❑No <br /> • Septic tank baffles are intact:Inlet ®Yes ❑No Outlet ®Yes ❑No <br /> • Plastic Concrete Outlet Plastic Metal <br /> Baffle material-Inlet� � EMetal � DConcreteC <br /> Effluent filter is present ['Yes ZNo <br /> • Effluent filter is free of debris DYes ❑No Not Applicable <br /> • Liquid level in tank relative to invert of outlet ❑At ®Above ['Below <br /> If above or below invert outlet,please explain: No power to run pump.... <br /> • Scum layer 8 (inches) Sludge layer 8 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume DYes ®No <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 ❑No <br /> (If"No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was onto test the pump(s):DYes ®No <br /> Page 3 of 8 <br />