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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> ❑ Steel . <br /> ® Plastic <br /> ❑ Fiberglass <br /> ® Other(explain) <br /> Unknown <br /> • Is the septic tank accessible? gYes ❑No <br /> • Septic tank volume in gallons /oar, <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> ❑Permit Records 4i2 Measured❑Stamped on Tank 0 Other <br /> • Septic tank risers are at ground level ❑Yes tiiNo <br /> • Tank appears to be free from defects,lbaking and signs of deterioration Wes ❑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 lids)is intact ( Yes ❑No <br /> • Septic tank baffles are intact Inlet Wes ❑No Outlet' }Yes ❑No <br /> • Baffle material-Inlet OPlastic BConcrete ❑Metal Outlet[]Ylastic EaConcrete OMetal <br /> Effluent filter is present ❑Yes �No <br /> • Effluent filter is free of debris ❑Yes ❑No RNot Applicable <br /> • Liquid level in tank relative to invert of outlet jgAt ['Above ['Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer A" (inches) Sludge layer AYlinches) <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 />