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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> igConcrete <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 WOO <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> (Permit Records 0 Measured 0 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;Sixes ❑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 Wes ❑No Outlet $1Yes ❑No <br /> • Baffle material-Inlet Plastic riConcrete OMetalOutletPlastic OConcrete ['Metal <br /> Effluent filter is present ❑Yes No <br /> • Effluent filter is free of debris ❑Yes ❑No pot Applicable <br /> • Liquid level in tank relative to invert of outlet gfAt ❑Above ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer L4 (inches) Sludge layer R (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume Dyes lNo <br /> Indicate where sludge measured from:❑inlet [Middle N 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 ❑No <br /> (If"No,"skip the rest of section 4) <br /> • At the time�pof this evaluation the power was on to test the pump(s): Yes DNo <br /> �G f Page 3 of 8 <br />