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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> • Concrete. <br /> Steel <br /> 0 Plastic. <br /> r Fiberglass . . <br /> El Other(explain) <br /> 0 . Unknown . . <br /> • Is the septic tank accessible? Ves ❑No <br /> • Septic tank volume in gallons t( U <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> ❑ Permit Records❑ Measured❑ Stamped on Tank❑ Other <br /> • Septic tank risers are at ground level I:Yes ❑No <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 74,Yes ❑No <br /> • Septic tank baffles are intact: Inlet %Yes ❑No Outlet IgYes ❑No <br /> • Baffle material -Inlet VA'lastic DConcrete ❑Metal OutletPlastic DConcrete OMetal <br /> Effluent filter is present ['Yes XNo <br /> • Effluent filter is free of debris ❑Yes ❑No ZNot Applicable <br /> • Liquid level in tank relative to invert of outlet pclAt ❑Above ❑Below <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 S6No <br /> Indicate where sludge measured from: ['Inlet ❑Middle gOutlet <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 : .Yes ❑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):Wes ❑No • <br /> Page 3 of 8 <br />