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U <br /> Oregon Department of Environmental Quality <br /> Tank pumped and inspected by Farmers Septic previous to drainfield inspection <br /> • The septic tank material is: <br /> ❑ Concrete <br /> ® Steel <br /> (❑ Plastic <br /> ® Fiberglass <br /> ® Other(explain) <br /> ® Unknown <br /> • Is the septic tank accessible? ['Yes ❑No <br /> • Septic tank volume in gallons <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> 0 Permit Records 0 Measured❑Stamped on Tank 0 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 of the septic tank below.For example, <br /> evidence of gas corrosion,cracks,leaks,ctc. <br /> • Septic tank lid(s)is intact ❑Yes ❑No <br /> • Septic tank baffles are intact:Inlet ❑Yes ❑No Outlet ❑Yes ❑No <br /> • Baffle material-Inlet(Plastic irtconcrete (Metal Outlet rPlastic Concrete ❑Metal <br /> Effluent filter is present [Nes ❑No <br /> • Effluent filter is free of debris [Nes ❑No ['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 [Wes ❑No <br /> Indicate where sludge measured from:❑Inlet ['Middle ❑Outlet <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 ❑Yes ❑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 ®No <br /> Page 3 of 8 <br />