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Oregon Department of Environmental Quality <br /> Another company did the septic tank part of this evaluation <br /> • The septic tank material.is: <br /> Concrete <br /> Ti Steel <br /> O Plastic. <br /> Fiberglass <br /> TiEl Other(explain). <br /> Unknown <br /> • Is the septic tank accessible? ❑Yes ONo <br /> • Septic tank volume in gallons <br /> • Tank volume determined by:Check all that,apply,add comments below as needed <br /> []Permit Records 0 Measured❑Stamped on Tank❑'Other <br /> • Septic tank risers are at ground level ❑Yes ONo. <br /> • Tank appears to be free from defects,leaking and signs of deterioration ONo Yes <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 lids)is intact ❑Yes ONo <br /> •. Septic tank baffles are intact:Inlet ❑Yes ONo Outlet :Yes ONo <br /> • Baffle material-Inlet EIPlastic pconcrete [Metal:Outlet.17,Plastic OConcrete EMetal <br /> Effluent filter is.present [ Yes ONo <br /> • Effluent filter is free of debris .DYes ONo :Not Applicable <br /> • Liquid level in tank relative to invert of outlet DAt DAbove ❑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 ONo <br /> Indicate where sludge measured from:❑Inlet ❑Middle DOutlet <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 10No <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 ONo <br /> Page 3 of 8 <br />