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Oregon Department of Environmental Quality <br /> • <br /> • The septic tank material is: <br /> gConcrete <br /> Steel <br /> Q Plastic <br /> • D Fiberglass <br /> 0 . Other(explain) <br /> ® . Unknown • . <br /> • Is the septic tank accessible? Wes ONo <br /> • Septic tank volume in gallons WOO <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> • <br /> txt Permit Records[]Measured D Stamped on Tank Other <br /> • Septic tank risers are at ground level Yes ONo <br /> • Tank appears to be free from defects, leaking and signs of deterioration 1Yes 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 ONo <br /> • 'Septic tank baffles are intact Inlet gYes .[(No Outlet 1(Yes ONo <br /> • .•.Baffle material-Inlet Plastic 'DConcrete [,Metal OutletPlastic [Concrete ❑Metal • <br /> Effluent filter is present DYes itglNo . <br /> • Effluent filter is free of debris DYes ONo pilNot Applicable <br /> • Liquid level in tank relative to invert of outlet NAt [Above ['Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 3 . .(inches) Sludge layer 6 (inches) <br /> • ' Scum and Sludge layer more than 35%-of the total tank volume [Yes tgjpo <br /> Indicate where sludge measured from:[]Inlet [Middle Noutlet <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 giros ONo <br /> (If"No,"skip the rest of section 4) <br /> • . At the time of this evaluation the power was on test the pump(s): Yes ONo <br /> Page3of8 <br />