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Oregon Department of Environmental Quality <br /> * The septic tank material is: <br /> 1 Concrete <br /> _ Steel <br /> 7-1 <br /> Plastic <br /> j--i <br /> _]Fiberglass <br /> Other(explain) <br /> j Unknown <br /> * Is the septic tank accessible? ±—x I Yes No <br /> * Septictank volume in gallons 1,000 <br /> * Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit Records ; x_j Measured ]Stamped on Tank L IOther <br /> * Septic tank risers are at ground level ( x j Yes L ; No <br /> * Tank appears to be free from defects, leaking and signs of deterioration i xJ Yes �_i 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 x I Yes No. <br /> * Septic tank baffles are intact: Inlet I ))j Yes ! �I No Outlet I x jYes I l INo <br /> * Baffle material-Inlet l_x Plastic f Concrete j Metal <br /> Outlet 3 x j Plastic L i I <br /> Concrete Metal <br /> * Effluent filter is present _ 1 Yes x No <br /> * Effluent filter is free of debris I Yes ! No j Not applicable <br /> * Liquid level in tank relative to invert of outlet F x j At 1 _ Above L s Below <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 Yes L_x_j No <br /> Indicate where sludge measured from: ( :Inlet L j Middle I.- x a Outlet <br /> * Additional comments: <br /> 4. Dosing tank/Pump Basin <br /> Dosing tanks use a pump to send effluent to a treatment unit or soil absorption field. <br /> * The septic system has a dosing tank �_x__{Yes j j No <br /> (If"No,"skip the rest of section 4) <br /> * _!No <br /> At the time of this evaluation the power was on to test the pump(s): Yes _x <br /> ;____ <br /> Page 3 of 8 <br />