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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> Steel <br /> O Plastic <br /> 0 Fiberglass <br /> 0 Other(explain) <br /> ® Unknown <br /> • Is the septic tank accessible? EYes ZNo <br /> • Septic tank volume in gallons krID <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> ❑Permit Records ❑Measured ❑ Stamped on Tank g Other <br /> • Septic tank risers are at ground level EYes g]No <br /> • Tank appears to be free from defects, leaking and signs of deterioration EYes [2]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 /> Tar V- !roc-( ce mil Src yv IK 1e4KS <br /> • Septic tank lid(s) is intact jZfYes ENo <br /> • Septic tank baffles are intact: Inlet 21Yes ENo Outlet OYes ENo <br /> • Baffle material -Inlet ElPlastic Croncrete ®Metal Outlet ICIPlastic [Concrete ,Metal <br /> Effluent filter is present EYes Lf No <br /> • Effluent filter is free of debris EYes ENo Not Applicable <br /> • Liquid level in tank relative to invert of outlet EAt ZAbove EBelow <br /> If above or below invert outlet,please explain: <br /> • Scum layer (inches) Sludge layer (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume . .Yes ENo <br /> Indicate where sludge measured from: ❑Inlet ZMiddle ❑Outlet <br /> • Additional Comments: <br /> 4. Dosing tank/Pump Basin (1 I Pr <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 ENo <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 />