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Oregon Department,of.Environmental Quality <br /> ctirl <br /> • <br /> The septic tank material is: <br /> az Concrete <br /> 12 Steel <br /> 0 Plastic <br /> Fiberglass <br /> D Other(explain) <br /> Unknown <br /> • is the septic tank accessible? INYes ❑No <br /> • Septic tank volume in gallons ti_so <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records D Measured D Stamped on Tank a Other <br /> • <br /> Septic tank risers are at ground level ) Yes ONo <br /> • Tank appears to be free from defects,leaking and signs of deterioration( Yes ONo. <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 pies ONo <br /> • Septic tank-baffles are intact:Inlet lYes ONe Outlet []Yes ONo <br /> • Baffle material-Inlet •lastic .Concrete ['Metal.Outlet MPlastic OConcrete OMetal <br /> Effluent filter is present 0Yes ONo <br /> • Effluent filter is free of debris Yes ONo DNotApplicable <br /> • Liquid level in tank relative to invert of outlet cgAt ['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 fg,No <br /> Indicate where sludge measured from:['inlet ['Middle ['Outlet <br /> • Additional.Comments: <br /> 4. Dosing tank./Pump Basin <br /> Dosingtanks use a;pump to send effluent to a treatment unit or.a soil absorption field. <br /> • The septic system has a dosing tank ['Yes DNo <br /> (If"No,"skip the rest of section 4). <br /> • At the time of this:evaluation the power was on to test the pumps):['Yes DNo <br /> Page 3 of 8 <br />