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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> [� Concrete <br /> E. Steel <br /> U Plastic <br /> ❑ Fiberglass <br /> ri Other(explain) <br /> C Unknown <br /> • Is the septic tank accessible? ®Yes ❑No <br /> • Septic tank volume in gallons1000 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records® Measured❑ 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 [1]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 71Yes ❑No <br /> • Septic tank baffles are intact: Inlet glYes ❑No Outlet ®Yes ❑No <br /> • Baffle material-Inlet[ Plastic ❑Concrete ❑Metal Outlet F7Plastic EConcrete [—Metal <br /> Effluent filter is present DYes No <br /> • Effluent filter is free of debris :Yes ❑No Not Applicable <br /> • Liquid level in tank relative to invert of outlet At DAbove ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 1 (inches) Sludge layer3 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ['Yes No <br /> Indicate where sludge measured from: [Inlet ❑Middle QOutlet <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 121No <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 DNo <br /> Page 3 of 8 <br />