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y <br /> Oregon Department of Environmental Quality <br /> * The septic tank material is: <br /> x I Concrete <br /> 'Steel <br /> j Plastic <br /> Fiberglass <br /> L-A Other(explain) <br /> L.- <br /> A Unknown <br /> * Is the septic tank accessible? I x Yes _ I No <br /> * Septic tank volume in gallons 1000 <br /> * Tank volume determined by:Check all that apply,add comments below as needed <br /> Tx ]Permit Records pi Measured L Stamped on Tank I _iOther <br /> * Septic tank risers are at ground level I x I Yes I ._ ]No <br /> * Tank appears to be free from defects,leaking and signs of deterioration x .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 I xI Yes L No <br /> * Septic tank baffles are intact: Inlet x 'Yes I No Outlet I x Yes Flo <br /> * Baffle material-Inlet ; x-1 Plastic 1 J Concrete L 1 Metal <br /> Outlet x1 Plastic I I Concrete { 1 Metal <br /> * Effluent filter is present ,Yes x No <br /> * Effluent filter is free of debris _j Yes .. . No ;..x ,Not applicable <br /> * Liquid level in tank relative to invert of outlet I_... .At x ,Above Below <br /> If above or below invert outlet,please explain: VALVE WAS TURNED OFF/WE TURNED BACK ON <br /> * Scum layer 0 (inches) Sludge layer 3 (inches) <br /> * Scum and Sludge layer more than 35%of the total tank volume Yes x ;No <br /> Indicate where sludge measured from: ;Inlet Middle ; x ;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 j x ;Yes j 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): x Yes ;No <br /> Page 3 of 8 <br />