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. Oregon Department of Environmental Quality <br /> • <br /> • The septic tank materialis: <br /> . EConcrete <br /> . Steel <br /> ® Plastic <br /> . E Fiberglass <br /> . • ❑ Other(explain) <br /> ® Unknown • <br />• . • . Is the septic tank accessible? iYes ❑No <br /> • • Septic tank volume in.gallons <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.- Q Yes .❑No <br /> • Tank appears to be free from defects,leaking and signs of deterioration Wes ❑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 /> • <br /> • • Septic tank lid(s)is intact vlYes ❑No • <br /> • Septic tank baffles are intact:Inlet Wes ❑No Outlet [1'es ❑No <br /> • Baffle material-Inlet 11 •lastic Croncrete []Metal Outlet GI'lastic [,Concrete ❑Metal <br /> Effluent f lter is present DYes SkTo • • . <br /> . • Effluent filter is free of debris DYes ❑No [J Not Applicable <br /> . • Liquid level in tank relative to invert of outlet cgAt DAbove ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 1 (inches) Sludge layer Li (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ['Yes 111No <br /> . . Indicate where sludge measured from:❑Inlet ❑Middle. 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 [Wes plo <br /> . <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 ❑No <br /> . Page3of8 <br />