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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> g Concrete <br /> ❑ Steel <br /> ❑ Plastic <br /> ❑ Fiberglass <br /> ❑ Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible? EYes 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 0 Measured ❑ Stamped on Tank❑ Other <br /> • Septic tank risers are at ground level EYes ENo <br /> • Tank appears to be free from defects, leaking and signs of deterioration EYes 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 EYes No Outlet EYes No <br /> • Baffle material - Inlet®Plastic OConcrete [Metal Outlet pPlastic [Concrete [Metal <br /> Effluent filter is present EYes 0No <br /> • Effluent filter is free of debris EYes No ENot Applicable <br /> • Liquid level in tank relative to invert of outlet 0At Above Below <br /> If above or below invert outlet, please explain: <br /> • Scum layer 4 (inches) Sludge layer 12 (inches) <br /> • Scum and Sludge layer more than 35% of the total tank volume EYes 0No <br /> Indicate where sludge measured from: ❑Inlet (iMiddle ❑✓ 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 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): EYes ❑No <br /> Page 3 of 8 <br />