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Oregon Department of Environmental Quality <br /> a. The septic tank material is: <br /> DI Concrete <br /> Steel <br /> 0 Plastic <br /> ri Magi= <br /> In Other team) <br /> ci_ Unlmown <br /> • Is the septic tank accessible? MYes ONo <br /> • Septic tank volume in gds 000 <br /> • Meek volume determined by:Check all that apply,add c below as needed <br /> Permit Records Kb/Insured 0 Stamped on Tack❑Other <br /> a Septic tank risers are at grotind level ❑Yea <br /> • Mink appears to be free from defects,lashing and signs:of deterintation. Yes ONO <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 [Yes ❑No <br /> a. Septic tank baffles'are intact Inlet JYes ONO Outlet ❑Yes ❑No <br /> a Baftlematarlsl- nil tPiaslmo Wonerate ['MetalOufletC?lastic 1F,,,Concrete OMetal <br /> Hatted filter is present ❑Yea IgiNo <br /> • <br /> Effluent filter is free of debris ❑Yes ❑No lailslotApplicable <br /> a Liquid-level in tank relative to invert of outlet !TAt •❑Above ❑Below <br /> If above or below invert outlet,please captain <br /> a Scam layer VA'(Ynches) Sludge layer".0 gnaws) <br /> • Scum andSludge:layer more than 35%of the total tank volume ❑Yes XINo <br /> Indicate where sludge measured from:❑Inlet ❑Middle ❑Outlet <br /> * Maimed Comments: • <br /> . Writ acid riser ito b>radt <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 /> a The septic system has a dosing tank ❑Yes FINo <br /> (If No,"skip the rest of section 4) <br /> • At the time ofthis evaluation the power was on to test the pump(s):❑Yes DNa <br /> Page 3 of 8 <br />