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Oregon Department of Environmental Quality <br /> Tank was pumped at time of inspection and passes at this time. <br /> • The septic tank material is: <br /> R Concrete <br /> El Steel <br /> Plastic <br /> Fiberglass <br /> ri Other(explain) <br /> r 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 /> ❑Permit Records®Measured❑ Stamped on Tank❑ Other <br /> • Septic tank risers are at ground level DYes ENo <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 [No Outlet ©Yes ❑No <br /> • Baffle material-Inlet VPlastic [Concrete Metal Outlet iePlastic 0Concrete EjMetal <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 ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 3 (inches) Sludge layer 7 (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 /> 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 ©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): DYes ['No <br /> Page 3 of 8 <br />