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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> ❑ Steel <br /> D PIastic <br /> • Fiberglass <br /> ❑ Other(explain) <br /> fl Unknown <br /> • Is the septic tank accessible? EYes No <br /> • Septic tank volume in gallons 425 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records VI Measured❑ Stamped on Tank[i] Other <br /> • Septic tank risers are at ground level ['Yes IZINo <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, etc. <br /> The lid does not seal tight to the tank and there are roots groing into the tank which means it <br /> is not watertight. <br /> • Septic tank lid(s)is intact JYes ❑No <br /> • Septic tank baffles are intact:Inlet EYes [2]No Outlet ZYes ❑No <br /> • Baffle material-Inlet i❑Plastic ❑Concrete Metal Outlet rPlastic 1[Concrete EMetal <br /> Effluent filter is present EYes No <br /> • Effluent filter is free of debris EYes :No (Z]Not Applicable <br /> • Liquid level in tank relative to invert of outlet ZAt ❑Above EBelow <br /> If above or below invert outlet,please explain: <br /> • Scum layer 6 (inches) Sludge layer 12 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ZYes ❑No <br /> Indicate where sludge measured from: ❑✓Inlet EMiddle ❑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 EYes [Z]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):EYes ❑No <br /> Page 3of8 <br />