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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> lJ Concrete <br /> ® Steel <br /> D Plastic <br /> ® Fiberglass <br /> ® Other(explain) <br /> D Unknown <br /> • Is the septic tank accessible?. ®Yes [No <br /> • Septic tank volume in gallons 1000 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> 0 Permit Records®Measured 0 Stamped on Tank 0 Other <br /> • Septic tank risers are at ground level DYes ®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 ®Yes DNo Outlet DYes ®No <br /> • Baffle material-Inlet([nPlastic riConcrete Fri Metal Outlet riPlastic [{Concrete gMetal <br /> Effluent filter is present Dyes ®No <br /> • Effluent filter is free of debris Dyes []No ®Not Applicable <br /> • Liquid level in tank relative to invert of outlet ®At ['Above OBelow <br /> If above or below invert outlet,please explain: <br /> • Scum layer 4 (inches) Sludge.layer 18 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ['Yes ®No <br /> Indicate where sludge measured from:['Inlet ['Middle DZ Outlet <br /> • Additional Comments: <br /> Outlet baffle was plugged and needs replaced <br /> 4. Dosing tank 1 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 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):['Yes ONo <br /> Page 3 of 8 <br />