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r <br /> Oregon Department of Environmental Quality <br /> * The septictank material is; <br /> x. Concrete <br /> Steel <br /> Plastic <br /> L_..J Fiberglass. <br /> [:Other(explain) <br /> Unknown7-1. <br /> * 'Is the septic:tank accessible? x I Yes. No <br /> * Septic tank volumein gallons 1,000. <br /> * Tank volume determined by Check all thatapply,add:comments below as needed <br /> U :Permit.Records. i } ]Stamped on Tank Other <br /> . .X Measured <br /> • Septic tank;risers are at,ground level. ( _j Yes <br /> 170 No <br /> * <br /> Tank appears to be free from defects;leaking:and signs of deterioration x 1'Yes, rj No <br /> If you.answered"No,"please describe the condition of the'septictank below.For example, <br /> evidence of gas corrosion,cracks,leaks,etc. <br /> * Septic:tank lid(s)is intact Xx Yes No <br /> * Septic tank baffles are intact: Inlet ( x 1 Yes 11 No Outlet x]Yes No <br /> * Baffle material-Inlet i ( Plastic I iConcrete LX j Metal <br /> Outlet Mastic ;;Concrete: x r Metal <br /> * Effluent filter is present .Yes I x j.No <br /> * Effluent filter is free of debris = (Yes -:No x_ Not applicable <br /> * Liquid level in tank relative toinvert of outlet. [ x I At I`j Above j <br /> q <br /> If above or below invert outlet,please:explain: <br /> * SCUm layer 2 (inches) Sludge layer 2 .. (inches) <br /> * Scum and:Sludge layer more than 35%of the total tank volume ( i Yes x (No <br /> Indicate wheresiudge measuredfrom: r I Inlet ' 'Middle x1:Outlet <br /> * Additional comments: <br /> 4. Dosing tank/Pump Basin <br /> Dosing tanks use:a pump to send effluent to a treatment:unit or soil absorption field. <br /> * The septicsystem has a<dosing tank I.Yes x i No <br /> .(If"No," the rest ofsection.4) <br /> * At the time of this evaluation the power was on to test the pump(s): E l Yes ;No <br /> Page'a of 8 <br />