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Oregon Department <br /> of Environmental Quality <br /> ac ei <br /> • Dosing tank capacity <br /> ' (gallons) 'S,X.t-2 x 57 . <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> g_Permit Records lid Measured 0 Stamped on Tank f Other <br /> • Dosing tank material Conc.st <br /> • Dosing tank appears to be watertight and:in good condition F:!Yes ONo <br /> • Dosing tank lid is intact E 4 Yes ONo <br /> • Electrical components are sealed..and,watertight DYesNo <br /> • Pump/siphon is functional DYes DNo (tk,10 , <br /> • Type of Pump ODemand dose ETime dose <br /> • Pump control mechanism is functional(floats,pressure transducer)DYes ONo. AC/ <br /> 14/1/0 <br /> • There is a high water alarm Wes ONo <br /> • The high water alarm:(audible and visual)is working DYes ONo ONot:Applicabl1"' ' J <br /> • Type.of screen. <br /> • Screen is clean and free of debris *.Yes DNo-:Screen cleaned for this evaluation(,tYes ONo <br /> • Scum/sludge present in Dosing,tank. PA Yes ONo <br /> • Scum layer O (inches) Sludge layer (inches) <br /> • Additional.Comments:CekAlsok G +4- . Jtrk ' ( poop , .. <br /> SettAi< ;., ^��: et‘st, hA 14/.1A4‘ 9th 14 <br /> Owe t241v iAu ile,10 - e fev t'9 U1: elzr ..'ew.� 4),C. 1 fc°%-.1 - LAS <br /> 5. Soil absorption system. <br /> The soil absorptionsystem is a set of trenches that receiveseffluent from the septic tank and <br /> filters the effluent before it enters the groundwater. <br /> • The septic system has a soil absorption system[Yes DNo []Unknown <br /> • Was the soil absorption system part of the evaluation?DYes No []See note below <br /> lithe soil absorption system was not evaluated,please explain below(for example unable to <br /> locate,. ientdi I no aut ooze t s=lathe evaluationr <br /> • Absorption distribution []Equal ['Serial ['Pressure ['Equal via pressure <br /> • <br /> Absorption lines construction material: <br /> D Gravel and pipe 0 Chamber [Tile. D Polystyrene foam and pipe []Other <br /> • Absorption distribution unit(s):Odropbox Ohydrosplitter[]equal distribution box. <br /> D Intact [Damaged 0 N/A. <br /> • Absorption distribution unit(s)are free of debris or solids Oyes ONo'0 N/A <br /> Page 4 of 8 <br />