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{i( <br /> •._ <br /> Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> g Concrete <br /> ® Steel <br /> ❑ Plastic <br /> Q Fiberglass <br /> ® Other(explain) <br /> ® Unknown <br /> • Is the septic tank accessible? JYes ❑No <br /> • Septic tank volume in gallons 630 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> 0 Permit Records®Measured 0 Stamped on Tank❑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,etc. <br /> • Septic tank lid(s)is intact ®Yes ❑No <br /> • Septic tank baffles are intact: Inlet IYes ❑No Outlet IYes ❑No <br /> • Baffle material-Wet(Plastic {Concrete nMetal Outlet rPlastic (Concrete [Metal <br /> Effluent filter is present ❑Yes No <br /> • Effluent filter is free of debris ['Yes ONo ®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 14 (inches) Sludge layer 15 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ®Yes ❑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):DYes ONO <br /> Page 3 of 8 <br />