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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> x Concrete <br /> Steel <br /> Plastic <br /> Fiberglass <br /> Other(explain) <br /> Unknown <br /> • Is the septic tank accessible? x Yes No <br /> • Septic tank volume in gallons 1,000 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit Records x Measured Stamped on Tank Other <br /> • Septic tank risers are at ground level Yes x No <br /> • Tank appears to be free from defects,leaking and signs of deterioration x 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 x Yes No <br /> • Septic tank baffles are intact: Inlet x Yes No Outlet x Yes No <br /> • Baffle material-Inlet Plastic Concrete Metal <br /> Outlet x Plastic Concrete Metal <br /> • Effluent fitter is present Yes x No <br /> • Effluent filter is free of debris Yes No x Not applicable <br /> • liquid level in tank relative to invert of outlet x At Above Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 4 (inches) Sludge layer 3 finches) <br /> • Scum and Sludge layer more than 35%of the total tank volume Yes x No <br /> Indicate where sludge measured from: Inlet x 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 soil absorption field. <br /> • The septic system has a dosing tank Yes x No <br /> (If"No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was on to test the purnp(s). Yes No <br /> Page 3 of S <br />