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::Oregon Department of Erivirorimental Quality 11 <br /> • Dosing tank capacity (gallons) <br /> • Tams volume determined by: Check allthat apply,add comments below as needed <br /> 0 Permit Records❑Measured 0 Stamped on Tok 0 Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition ❑Yes ❑No <br /> • Dosing tank lid is intact; ['Yes ONO <br /> • Electrical components are sealed and watertight ['Yes: [No <br /> • Pumps siphon is functional ❑Yes ONO <br /> #i Type of Pump;;;❑Demand dose ❑Time dose:: <br /> Pump;control mechanism is functional(floats,pressure transducer) ❑Yes ❑No <br /> • There is a high;water alarm:Nes ❑No <br /> • The high water alarm(audible and visual)is working ❑Yes ❑No ❑Not Applicable <br /> • Type of screen <br /> • Screen is clean and:free of debris❑Yes ONO-Screen cleaned for this evaluation[(Yes ❑No <br /> • <br /> Scum/sludge present in Dosing tank ❑Yes ❑No <br /> • • Scum layer (inches); Sludge.layer (inches) <br /> • Additional Comments:: <br /> 5i. Soil absorption system <br /> The soil absorption system is a set of trenches that receives effluent from the septic tank and <br /> filters:the effluent before it enters the groundwater. <br /> • The septic system has a soil absorption system la es ONO ['Unknown <br /> • Was the soil absorption system part of the evaluation? Yes ❑No ['See note below <br /> If the soil absorption system was not evaluated,:please explain below(for example unable to <br /> locate,client did not authorize this part of the evaluation) <br /> • Absorption distribution ®Equal [(Serial ['Pressure ❑Equal via pressure: <br /> • Absorption lines construction material: <br /> Gravel and pipe ❑Chamber ❑Tile; ❑Polystyrene foam and pipe ❑Other <br /> • Absorption distributionunit(s): ❑dropbox❑hydrosplitter Dequal distribution box <br /> ❑Intact ❑Damaged [:! N/A <br /> •: Absorption distribution units)are free:of debris or solids ales ❑No Tri. N/A <br /> Page4of8 <br />