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• <br /> Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> M, Concrete <br /> Steel <br /> ❑ Plastic <br /> ❑ Fiberglass <br /> ❑ Other(explain) <br /> In Unknown <br /> • Is the septic tank accessible?Ares DNo <br /> • Septic tank volume in gallons <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records 0 Measured 0 Stamped on Tank Other <br /> • Septic tank risers are at ground level Wes ONo <br /> • Tank appears to be free from defects,leaking and signs of deterioration IX]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 Yes ONo <br /> • Septic tank baffles are intact:Inlet IFlyes ONo Outlet gYes ONo <br /> • Baffle material-Inlet elastic ❑Concrete OMetal let Plastic ❑Concrete OMetal <br /> Effluent filter is present Dyes No <br /> • Effluent filter is free of debris Oyes ONo ( Not Applicable <br /> • Liquid level in tank relative to invert of outlet IXAt DAbove DBelow <br /> If above or below invert outlet,please explain: <br /> • Scum layer 7 (inches) Sludge layer 3 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume Dyes 1No <br /> Indicate where sludge measured from:Dlnlet 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 ISIblo <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):Dyes ONo <br /> Page 3 of S <br />