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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> E Concrete <br /> ❑ Steel <br /> El Plastic <br /> CI Fiberglass <br /> ci Other(explain) <br /> 17 Unknown <br /> • Is the septic tank accessible? ®Yes ❑No <br /> • Septic tank volume in gallons/CePV <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> ®Permit Records❑ Measured El Stamped on Tank❑Other <br /> • Septic tank risers are at ground level EYes ❑No <br /> • Tank appears to be free from defects,leaking and signs of deteriorationlK]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 iYes ❑No <br /> • Septic tank baffles are intact: Inlet ®Yes ❑No Outlet EYes ONo <br /> • Baffle material-Inlet rjE Plastic Concrete DMetal Outlet Pn3lastic ❑Concrete ❑Metal <br /> Effluent filter is present ❑Yes RiNo <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 L/ (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume EYes ❑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 NYes ❑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 No <br /> Page 3 of 8 <br />