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• Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> O Concrete • <br /> E. Steel <br /> Plastic <br /> 0 Fiberglass <br /> ❑ Other(explain) <br /> ❑ Unknown • <br /> • Is the septic tank accessible? [Wes [ No <br /> • Septic tank volume in gallons t,Zeb <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> XPermit Records❑Measured❑Stamped on.Tank❑Other <br /> • Septic tank risers are at ground level ['Yes NNo <br /> • Tank appears to be free from defects,leaking and signs of deterioration['Yes gNo <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 /> V)a b I. hitcotS ,rlcrAv <br /> • Septic tank lidais irftact ❑Yes (No <br /> • Septic tank baffles are intact:Inlet CX Yes ❑No Outlet [EYes ONo <br /> • Baffle material-Inlet❑Plastic ❑Concrete ` metal Outlet OPlastic 0Concrete ligMetal <br /> Effluent filter is present ❑Yes allo <br /> • Effluent filter is free of debris ['Yes ❑No [XNot Applicable <br /> • Liquid level in tank relative to invert of outlet EAt ['Above OBelow <br /> If above or below invert outlet,please explain: <br /> • Scum layer (inches) • Sludge layer/.i (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume JXIYes ONo <br /> Indicate where sludge measured from: Klnlet ['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 o <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 ONo <br /> Page 3 of.8 <br />