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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> • Steel <br /> D Plastic <br /> El Fiberglass <br /> ® Other(explain) <br /> © Unknown <br /> • Is the septic tank accessible? EYes ❑No <br /> • Septic tank volume in gallons 1,000 <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> 0 Permit Records® Measured 0 Stamped on Tank 0 Other <br /> • Septic tank risers are at ground level 0Yes IZINo 6"deep <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 [jYes ❑No Outlet Yes ❑No <br /> • Baffle material-Inlet OPlastic MConcrete ❑Metal Outlet VPlastic CConcrete ❑Metal <br /> Effluent filter is present ❑Yes ®No <br /> • Effluent filter is free of debris DYes ❑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: <br /> • Scum layer 13 (inches) Sludge layer 6 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes mNo <br /> Indicate where sludge measured from:❑Inlet ❑✓ Middle ❑Outlet <br /> • Additional Comments: <br /> Tank appeared to be in good condition at this time <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 ZNo <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 />