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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> Steel <br /> Plastic <br /> r Fiberglass <br /> ri Other(explain) <br /> Ci Unknown <br /> • Ts the septic tank accessible? (2,,°'es ❑No <br /> • Septic tank volume in gallons /Dt) <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 J'To <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 (es ❑No <br /> • Septic tank baffles are intact:Inlet RYes ENo Outlet IgYes ❑No <br /> • Baffle material-Inlet nPlastic ❑Concrete vIetal Outlet EPlastic DConcrete PMetal <br /> Effluent filter is present ❑Yes Vallo <br /> • Effluent filter is free of debris ❑Yes ❑No tarot 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 (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 ['Yes igNo <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 />