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Oregon Department of Environmental Quality <br /> •. Dosing tank capacity (gallons). <br /> • Ts)*volume determined by: Check all:that apply,add comments below as needed <br /> 0 Permit Records D Measured 0 Stamped on Tank D Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition DYes ONo <br /> • Dosing tank lid is intact DYes ONo <br /> • Electrical components are sealed and watertight DYes ONo <br /> •: Pump/siphon is functional DYes ONo <br /> • Type of Pump ['Demand dose ['Time dose <br /> • Pump control mechanism is functional(floats,pressure transducer)DYes ONo <br /> • There is a high water alarm DYes ONo <br /> • The high water alarm(audible and visual)is working DYes ONo ONot Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris DYes ONo-Screen cleaned for this evaluation(]Yes ONo <br /> • Scum/sludge present in Dosing tank DYes ['No. <br /> • Scum layer (inches) Sludge layer (inches) <br /> •: Additional Comments: <br /> 5. 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 ElYes ONo:DUnknown <br /> • Was the soil absorption system part of the evaluation? Yes: ONo ['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 I Equal:['Serial ['Pressure DEqual via pressure <br /> • Absorption lines construction material: <br /> '►e Gravel and pipe 0 Chamber ❑Tile ❑Polystyrene foam and pipe DOther <br /> • Absorption distribution unit(s): Ddropbox Dhydrosplitter['equal distribution box <br /> D Intact D Damaged Iy;N/A /O :`Dry 54 , <br /> • Absorption distribution unit(s)are free of debris or solids DYes ONo N/A • <br /> Page4of8 <br />