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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> Steel <br /> 0 Plastic <br /> ❑ Fiberglass <br /> ❑ Other(explain) <br /> ❑ Unknown <br /> • Is the septic tank accessible? g,Yes ❑No <br /> • Septic tank volume in gallons 1500 <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> IZ Permit Records ❑Measured❑ Stamped on Tank❑Other <br /> • Septic tank risers are at ground level ( Yes ONO <br /> • Tank appears to be free from defects,leaking and signs of deterioration0Yes 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 NYes .❑No <br /> • Septic tank baffles are intact: Inlet [Yes ❑No Outlet %Yes ❑No <br /> • Baffle material-Inlet plastic CiConcrete ❑Metal Outlet atPlastic OConcrete ❑Metal <br /> Effluent filter is present DYes g[No <br /> • Effluent filter is free of debris DYes ❑Noliklot Applicable <br /> • Liquid level in tank relative to invert of outlet islAt DAbove ❑Below <br /> If above or below invert outlet,please explain: <br /> • Scum layer \Z... (inches) Sludge layer 30 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume NYes ❑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 ❑No <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 />