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• <br /> Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> E Concrete <br /> {l Steel <br /> ❑ Plastic <br /> Ej Fiberglass <br /> El Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible? lYes ❑No <br /> • Septic tank volume in gallons 1500 <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 ['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 DYes ❑No <br /> • Septic tank baffles are intact: Inlet ©Yes ❑No Outlet DYes ❑No <br /> • Baffle material-Inlet°Plastic °Concrete EMetal Outlet InPlastic E Concrete EMetal <br /> Effluent filter is present Dyes No <br /> • Effluent filter is free of debris [Yes ❑No ❑✓Not Applicable <br /> • Liquid level in tank relative to invert of outlet ✓❑At ['Above EBelow <br /> if above or below invert outlet,please explain: <br /> • Scum layer 0 (inches) Sludge layer 2 (inches) <br /> • Scum and Sludge layer more than 35% of the total tank volume Dyes No <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 Dyes ONo <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 /> Page 3 of 8 <br />