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• Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> 11' Concrete <br /> L Steel <br /> Plastic <br /> ® Fiberglass <br /> ❑ Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible? [Yes hi No <br /> • Septic tank volume in gallons I5oo <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> Permit Records❑Measured❑ Stamped on Tank❑Other_11 <br /> • Septic tank risers are at ground level DYes 1No (l' 1)e1 n l.J <br /> • Tank appears to be free from defects, leaking and signs of deterioration JYes ❑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 gYes ❑No <br /> • Septic tank baffles are intact: Inlet gYes ❑No Outlet ( Yes ❑No <br /> • Baffle material-Inlet❑Plastic MConcrete ❑Metal Outlet rIPlastic Concrete ['Metal <br /> Effluent filter is present [Yes '- No <br /> • Effluent filter is free of debris DYes ❑No yJNot Applicable <br /> • Liquid level in tank relative to invert of outlet yAt DAbove ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer 15 (inches) Sludge layer 15 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume ['Yes IgNo <br /> Indicate where sludge measured from:gInlet ❑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 DYes CCNo <br /> (If"No,"skip the rest of section 4) <br /> • At the time of this evaluation the power was onto test the pump(s): ['Yes ❑No <br /> Page 3 of 8 <br />