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Oregon Department of Environmental Quality <br /> • Theptic tank material is: <br /> i`i Concrete <br /> E Steel <br /> 0 Plastic <br /> fl Fiberglass <br /> rl Other(explain) <br /> Unknown <br /> • Is the septic tank accessible? Yes ❑No <br /> • Septic tank volume in gallons Sy al-Aar-5 <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> El Permit Records❑Measured❑ Stamped on Tank El Other <br /> • Septic tank risers are at ground level ❑Yes ❑No <br /> • Tank appears to be free from defects,leaking and signs of deterioration❑Yes ❑No <br /> If you answered"No,"please.describe the condition f the septic tank below.For example, <br /> evidence of gas corrosion,cracks,leaks, etc. <br /> • Septic tank lid(s)is intact [Nes ❑No <br /> • Septic tank baffles are intact:Inlet ❑Yes ❑No utlet ❑Yes ❑No <br /> • Baffle material-Inlet i—Plastic ❑Concrete ❑ etal Outlet :Plastic DConcrete EMetal • <br /> Effluent filter is present ❑Yes ❑No <br /> • Effluent filter is free of debris ❑Yes ❑No ON t Applicable <br /> • Liquid level in tank relative to invert of outlet ❑A ❑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 tota t volume Dyes ❑No <br /> Indicate where sludge measured from: [Inlet ❑ ddle ❑Outlet <br /> • Additional Comments: <br /> 4. Dosing tank/Pump Basin <br /> Dosing tanks use a pump to send effluent to a trea i i-nt unit or a soil absorption field. <br /> • The septic system has a dosing tank Dyes IINo <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): Eyes ❑No <br /> Page 3 of 8 <br />