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Oregon Department of Environmental Quality <br /> Report is for system location only <br /> • The septic tank material is: <br /> IZ Concrete <br /> ® Steel <br /> • Plastic <br /> ▪ Fiberglass <br /> El Other(explain) <br /> Ej Unknown <br /> • Is the septic tank accessible? EYes ❑No <br /> • Septic tank volume in gallons 1000 <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> ❑Permit Records 12]Measured❑ Stamped on Tank❑ Other <br /> • Septic tank risers are at ground level ZYes ❑No <br /> • Tank appears to be free from defects, leaking and signs of deterioration ZYes ❑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 ZYes ❑No Outlet ZYes ❑No <br /> • Baffle material-Inlet OPlastic OConcrete [Metal Outlet 17Plastic Concrete ®Metal _ <br /> Effluent filter is present ❑Yes ZINo <br /> • Effluent filter is free of debris ❑Yes ❑No IZINot Applicable <br /> • Liquid level in tank relative to invert of outlet IZAt ❑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 ❑No <br /> Indicate where sludge measured from: ['Inlet ❑Middle ❑Outlet <br /> • Additional Comments: <br /> Did not measure scum and sludge. Report for system locate only <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 IZINo <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 />