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• <br /> Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> N <br /> Concrete <br /> Steel <br /> ® Plastic <br /> Fiberglass <br /> CI Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible?gYes ENo <br /> • Septic tank volume in gallons OM <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> ,Permit Records❑Measured❑ Stamped on Tank E Other <br /> • Septic tank risers are at ground level Eyes io <br /> • Tank appears to be free from defects, leaking and signs of deterioration[Wes ENo <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 o 5 J"x 0601,4 e-. .4a r Iv.). <br /> • Septic tank baffles are intact: Inlet utlet Yes <br /> • Baffle material-Inlet a'lastic nConcrete []Metal Outlet Ziplastic [Concrete ❑Metal <br /> Effluent filter is present EYes 7tIo <br /> • Effluent filter is free of debris Eyes ENo Slot Applicable <br /> • Liquid level in tank relative to invert of outlet Kett EAbove EBelow <br /> If above or below invert outlet,please explain: <br /> • Scum layer I . (inches) Sludge layer C (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume Eyes ElNo <br /> Indicate where sludge measured from:❑Inlet EMiddle 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 Eyes gNo <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): Eyes ENo <br /> Page 3 of 8 <br />