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•OregOn Department of Environmental Quality <br /> :* :The septic tank material is: <br /> Concrete <br /> x Steel <br /> Plastic <br /> : Fiberglass <br /> Other(explain) <br /> Unknown <br /> • the:septic tank accesSible?. x Yes No <br /> * SePtic,tarik volume in'gallons 450 <br /> * Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit Records x ;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 x Yes ; I No <br /> _ <br /> If yoUensWered"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 !Yes No <br /> * Septic tank baffles are intact Inlet x !Yes ; f.No Outlet. I x Yes; ! No <br /> • <br /> * Baffle material Inlet Plastic x Concrete Metal <br /> Outlet Plastic X'!Concrete Metal <br /> • <br /> * Effluent filter is present ; Yes -x No <br /> * Effluent filter is free of debris Yes ; No ! x Not applicable <br /> * Liquid level in tank relative to invert of outlet .• x At Above ;Below <br /> If above or below invert outlet,please explain: <br /> * Scum layer 4 (inches) Sludge layer 2 (inches) <br /> • Scum and Skidgelayee.inore than 35%of the total tank volume Yes x' No <br /> Indicate where sludge measured from: : x 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 soil absorption field. <br /> * The septic system has a dosing tank Yes x No <br /> "No,".skip-the rest of section 4) <br /> * At thktiene of this eValuation the power was on to test the pump(s): Yes. No <br /> Page 3 of 8 <br />