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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> lEr Concrete <br /> El Steel <br /> • Plastic <br /> Q Fiberglass <br /> ® Other(explain) <br /> • Unknown <br /> • Is the septic tank accessible? ®Yes ENo <br /> • Septic tank volume in gallons 1000 <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> E Permit Records ® Measured E Stamped on Tank E Other <br /> • Septic tank risers are at ground level ®Yes ENo <br /> • Tank appears to be free from defects, leaking and signs of deterioration®Yes 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 ENo <br /> • Septic tank baffles are intact: Inlet ®Yes ENo Outlet ®Yes ENo <br /> • Baffle material -Inlet OPlastic 17Concrete EMetal Outlet VPlastic ❑Concrete Metal <br /> Effluent filter is present EYes No <br /> • Effluent filter is free of debris Eyes ENo Not Applicable <br /> • Liquid level in tank relative to invert of outlet At EAbove EBelow <br /> If above or below invert outlet, please explain: <br /> • Scum layer 1 (inches) Sludge layer2 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes No <br /> Indicate where sludge measured from: nlnlet ®Middle EOutlet <br /> • Additional Comments: <br /> This system is a septic and dosing tank combination. <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 dosingtank Yes ENo <br /> P Y <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 ENo <br /> Page 3 of 8 <br />