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Oregon Department of Environmental Quality <br /> • The septic tank material is: <br /> Concrete <br /> Steel <br /> Q Plastic <br /> • Fiberglass <br /> • Other(explain) <br /> O Unknown <br /> • Is the septic tank accessible? ]Yes ONo <br /> • Septic tank volu e in gallons Q.(1/3_ <br /> • • Tank volume dete fined by:Check all that apply,add comments below as needed <br /> 4 Permit Record. 0 Measured 0 Stamped on Tank 0 Other <br /> • Septic tank risers :re at ground level ►'1 Yes ONo '(p`fl1 ct' 0,c,A. t? r"v.ix-S <br /> • Tank appears to b free from defects,leaking and signs of deteriorationEYes ONo <br /> If you answered` o,"please describe the condition of the septic tank below.For example, <br /> evidence of gas corrosion,cracks, leaks,etc. <br /> • Septic tank lid(s) s intact EYes ONo . <br /> • Septic tank baffle- are intact:Inlet %Yes EINo Outlet Wes. []No <br /> • Baffle material-I let OPlastic OConcrete 114Metal Outlet IttPlastic OConcrete [,Metal <br /> Effluent filter is p,esent DYes MNo <br /> • Effluent filter is fr-e of debris DYes ONo 1NotApplicable <br /> • Liquid level in to relative to invert of outlet %At DAbove OBelow <br /> If above or below i nvert outlet,please explain: <br /> • Scum layer . (inches) Sludge layer 3 (inches) <br /> • Scum and Sludge layer more than 35%of the total tank volume DYes %No <br /> Indicate where slu•ge measured from: Dlnlet P=Middle DOutlet <br /> • Additional..Comm nts: <br /> 4. Dosing tank/Pu p Basin • <br /> Dosing tanks use pump to send effluent to a treatment unit or a soil absorption field. <br /> • The septic system as a dosing tank DYes 1:+No <br /> (If"No,"skip the est of section 4) <br /> • At the time of thisevaluation the power was on to test the pump(s):OYes.ONo <br /> Page 3 of 8 <br />