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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> IgConcrete <br /> Steel <br /> ® Plastic <br /> ® Fiberglass <br /> ® Other(explain) <br /> ® Unknown <br /> • Is the septic tank accessible? E]Yes ❑No <br /> • • Septic tank volume in gallons MOO <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 `2 Yes ❑No <br /> • Tank appears to be free from defects, leaking and signs of deterioration qiYes ❑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'JYes ❑No <br /> • Baffle material-Inlet!i�l Plastic OConcrete Metal Outle_____112Plastic OConcrete [Metal <br /> Effluent filter is present DYes 'JNo <br /> • Effluent filter is free of debris DYes ❑No [ Tot Applicable <br /> • Liquid level in tank relative to invert of outlet [6jAt DAbove ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer `I (inches) Sludge layer (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume DYes ❑No <br /> Indicate where sludge measured from: ['Inlet ['Middle MOutlet <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 7No <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 /> Page3of8 <br />