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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> g� Concrete <br /> I❑ Steel <br /> Ej Plastic <br /> r Fiberglass <br /> El Other(explain) <br /> • Unknown <br /> • Is the septic tank accessible? ®Yes ONo <br /> • Septic tank volume in gallons 1000 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records®Measured❑ Stamped on Tank❑ Other <br /> e. Septic tank risers are at ground level Eyes ®No <br /> • Tank appears to be free from defects,leaking and signs of deterioration®Yes ❑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 /> e Septic tank lid(s)is intact ®Yes ❑No <br /> • Septic tank baffles are intact:Inlet ZYes ❑No Outlet Yes ❑No <br /> • Baffle material-Inlet Plastic Concrete VMetal Outlet VPlastic ❑Concrete OMetal <br /> Effluent filter is present Eyes IZINo <br /> • Effluent filter is free of debris Eyes ❑No Not Applicable <br /> e Liquid level in tank relative to invert of outletAt Above <br /> ® ❑ B I <br /> e ow <br /> If above <br /> or below invert outlet,please explain: <br /> • Scum layer 4 (inches) Sludge layer 3 (inches) <br /> • • Scum and Sludge layer more than 35%of the total tank volume Eyes ®No <br /> Indicate where sludge measured from: ❑Inlet ❑Middle 0✓ Outlet <br /> A 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 Eyes 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): Eyes ❑No <br /> Page 3 of 8 <br />