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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> 'Cbncrete <br /> Steel <br /> • Plastic <br /> O Fiberglass <br /> ® Other(explain) <br /> O Unknown <br /> • Is the septic tank accessible? -Wes ❑No <br /> • Septic tank volume in gallons 1O0 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records 0 Measured 0 Stamped on Tank IN Other <br /> • Septic tank risers are at ground level I Wires ❑No <br /> • Tank appears to be free from defects,leaking and signs of deterioration Pees 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 Wes ❑No <br /> • Septic tank baffles are intact:Inlet EYes ❑No Outlet NYes ❑No <br /> • Baffle material-Inlet(Plastic OConcrete ' Metal let !Plastic OConcrete `4-Metal <br /> Effluent filter is present DYes XiNo <br /> • Effluent filter is free of debris Dyes ❑No jNot Applicable <br /> • Liquid level in tank relative to invert of outlet %At DAbove ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer L (inches) Sludge layer it- (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume Dyes NNo <br /> Indicate where sludge measured from: Din let %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 Dyes KNo <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):Dyes ❑No <br /> Page 3 of 8 <br />