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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> (Z Concrete <br /> D Steel <br /> O Plastic <br /> ® Fiberglass <br /> ® Other(explain) <br /> In Unknown <br /> • Is the septic tank accessible? ®Yes ❑No <br /> • Septic tank volume in gallons 1.000 <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records®Measured 0 Stamped on Tank 0 Other <br /> • Septic tank risers are at ground level ❑Yes ®No <br /> • Tank appears to be free from defects,leaking and signs of deterioration®Yes ❑No <br /> Ifou answered"No" describe the condition of the septic tank below.For example, <br /> Y � pleaseP <br /> evidence of gas corrosion,cracks,leaks,etc. <br /> • Septic tank lid(s)is intact ®Yes ❑No <br /> • Septic tank baffles are intact: Inlet ®Yes ❑No Outlet ®Yes ❑No <br /> • Baffle material-Inlet CIPlastic OConcrete [OMetal Outlet Plastic ®Concrete [Metal <br /> Effluent filter is present ❑Yes ONo <br /> • Effluent filter is free of debris ❑Yes ❑No ®Not Applicable <br /> • Liquid level in tank relative to invert of outlet ®At ❑Above ❑Below <br /> If above or below invert outlet,please explain: — <br /> • Scum layer 1 (inches) Sludge layer 12 (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 /> Tank is Buried approx 8-10"Deep <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 onto test the pump(s):[Res ❑No <br /> Page 3 of 8 <br />