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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> tg- Concrete <br /> ii Steel <br /> ❑ Plastic <br /> ❑ Fiberglass <br /> ✓ Other(explain) <br /> fl Unknown <br /> • Is the septic tank accessible? km Yes ❑No <br /> • Septic tank volume in gallons !L _( o"x lot-t''>C Si'') <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> KPermit RecordsRMeasured❑ 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 J,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 EgYes No <br /> • Septic tank baffles are intact:Inlet ►JYes ENo Outlet gfres ❑No <br /> • Baffle material-Inlet gPlastic ❑Concrete ❑Metal Outlet lastic ['Concrete DMetal <br /> Effluent filter is present ['Yes IgNo <br /> • Effluent filter is free of debris ['Yes ❑No Not Applicable <br /> • Liquid level in tank relative to invert of outlet kAt ❑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 ONo 6'7 °rte <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 ['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): ['Yes ❑No <br /> Page 3 of 8 <br />