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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> ILi Concrete <br /> ® Steel <br /> ® Plastic <br /> ® Fiberglass <br /> • Other(explain) <br /> ® Unknown <br /> • Is the septic tank accessible? ❑Yes NNo <br /> • Septic tank volume in gallons lo) <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> ❑Permit Records Measured❑ Stamped on Tank❑Other <br /> • Septic tank risers are at ground level EYes XI° <br /> • Tank appears to be free from defects,leaking and signs of deterioration L1 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 /> • Septic tank baffles are intact: Inlet Wes ❑No Outlet Wes ❑No <br /> • Baffle material-Inlet DPlastic OConcrete (►'CMetal Outlet Plastic Concrete gmetal <br /> Effluent filter is present ❑Yes RINo <br /> • Effluent filter is free of debris EYes ❑No E>1 Not Applicable <br /> • Liquid level in tank relative to invert of outlet [ At ['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 <br /> Indicate where sludge measured from: ❑Inlet ❑Middle Aoutlet <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 ❑Yeslo <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 />