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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Q Concrete <br /> Steel <br /> Q Plastic <br /> ❑ Fiberglass <br /> 7 Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible? ❑x Yes ❑No <br /> • Septic tank volume in gallons 1500 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑ Permit Records x❑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 DYes ❑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 DYes ❑No <br /> • Septic tank baffles are intact: Inlet DYes ❑No Outlet ❑x Yes ❑No <br /> • Baffle material-Inlet OPlastic ❑Concrete OMetal Outlet MPlastic ❑Concrete ❑Metal <br /> Effluent filter is present ❑Yes ONo <br /> • Effluent filter is free of debris EYes ❑No [Not Applicable <br /> • Liquid level in tank relative to invert of outlet ❑x At ❑Above ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 2 (inches) Sludge layer 5 (inches) Total Liquid Depth 60" <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes No <br /> Indicate where sludge measured from: ❑Inlet ['Middle ❑x 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 DYes ❑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): ❑x Yes ❑No <br /> Page 3 of 8 <br />