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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> E Concrete <br /> C Steel <br /> Plastic <br /> 0 Fiberglass <br /> fl Other(explain) <br /> l Unknown <br /> • Is the septic tank accessible? ®Yes ❑No <br /> • Septic tank volume in gallons 1800 <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 ❑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 /> • Baffle material-Inlet❑Plastic y.Concrete (Metal Outlet rPlastic VConcrete EMetal <br /> Effluent filter is present ❑Yes No <br /> • Effluent filter is free of debris ❑Yes ❑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: Back line cloaaed with roots. <br /> • Scum layer 10 (inches) Sludge layer 10 (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 /> Septic tank lid is on 18" of riser 4" above the surface. <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 on to test the pump(s): ❑Yes ❑No <br /> Page 3 of 8 <br />