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• <br /> Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> ❑ Steel <br /> in Plastic <br /> ▪ Fiberglass <br /> ❑ Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible? Wes ❑No <br /> • Septic tank volume in gallons /CO/) <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records Eq Measured In Stamped on Tank In Other <br /> • Septic tank risers are at ground level Wires ❑No <br /> • Tank appears to be free from defects,leaking and signs of deteriorationenYes ❑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 AYes ❑No <br /> • Septic tank baffles are intact:Inlet ®Yes ❑No Outlet [Wes ❑No <br /> • Baffle material-Inlet OPlastic ❑Concrete ❑Metal Outlet❑Plastic ®Concrete ❑Metal <br /> Effluent filter is present ❑Yes ❑Ido <br /> • Effluent filter is free of debris ❑Yes [No ❑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 (inches) Sludge layer OT (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 /> Tap I. p ln171Cl-1---" <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 VHo <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 allo <br /> Page 3 of 8 <br />