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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> x 1Concrete <br /> J <br /> Steel <br /> r <br /> i Plastic <br /> Fiberglass <br /> Other(explain) <br /> (- 1 Unknown <br /> * Is the septic tank accessible? <br /> [7 Yesr� No <br /> i <br /> * Septic tank volume in gallons 1,000 <br /> * Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit Records x ] Measured [ ?Stamped on Tank jOther <br /> * Septic tank risers are at ground level [ x I Yes ? ]No <br /> * Tank appears to be free from defects,leaking and signs of deterioration x ]Yes 1— 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 Lx j Yes [ j No <br /> * Septic tank baffles are intact: Inlet ? Yes [xi No Outlet I x fres i—yNo <br /> * Baffle material-Inlet Plastic Concrete [ j Metal <br /> –1 <br /> Outlet x Plastic L Concrete Metal <br /> * Effluent filter is present j Yes x No <br /> * Effluent filter is free of debris L i Yes ( 4 No i x ?Not applicable <br /> * Liquid level in tank relative to invert of outlet � x At i ;Above [ i Below <br /> If above or below invert outlet,please explain: <br /> * Scum layer 7 (inches) Sludge layer 5 (inches) <br /> * Scum and Sludge layer more than 35%of the total tank volume i ,€YesNo <br /> Indicate where sludge measured from: 1, ,'�.Inlet _i Middle ! x ;Outlet <br /> * Additional comments: <br /> THERE IS NO INLET BAFFLE. <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 I x I 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 Li No <br /> Page 3 of 8 <br />