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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> M. Concrete <br /> Steel <br /> El Plastic <br /> El Fiberglass <br /> El Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible? ❑Yes [ No <br /> • Septic tank volume in gallons gr)OC7 <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> Permit Records❑Measured❑ Stamped on Tank[ Other 7 r.W 9 <br /> • Septic tank risers are at ground level• ❑Yes [ to V?,1' 4ov,; e <br /> • Tank appears to be free from defects, leaking and signs of deterioration CI 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 WYes ❑No Outlet , `Yes ❑No <br /> • Baffle material-Inlet❑Plastic Concrete MMetal Outlet MiPlastic OConcrete Petal <br /> Effluent filter is present ['Yes to <br /> • Effluent filter is free of debris ❑Yes ❑No LNot Applicable <br /> • Liquid level in tank relative to invert of outlet OAt ❑Above ❑Below <br /> If above or below invert outlet, please explain: <br /> • Scum layer i7. (inches) Sludge layer / (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ❑Yes to <br /> Indicate where sludge measured from: ❑Inlet EMiddle [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 j1 o <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 />