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f - <br /> Oregon Department of Environmental Quality <br /> • Dosing tank capacity J O O (gallons) <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> Rrmit Records[ 'Measured❑ Stamped on Tank❑ Other <br /> • Dosing tank material C& 4 €411 <br /> • Dosing tank appears to be watertight and in good condition EKes No <br /> • Dosing tank lid is intact [es ENo <br /> • Electrical components are sealed and watertight s No <br /> • Pump/siphon is functional [v[es No <br /> • Type of Pump . [Kemand dose ❑Time dose <br /> • Pump control mechanism is functional(floats,pressure transducer) [ (s EiSo <br /> • There is a high water alarm[Yes ❑No <br /> • The high water alarm(audible and visual)is working 172<es ENo ENot Applicable <br /> • Type of screen i,T) '1;f. <br /> • Screen is clean and free of debris[2<s No-Screen cleaned for this evaluation EYes ENo <br /> • Scum/sludge present in Dosing tank ❑Yes EKo <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 12<es ENo ❑Unknown <br /> • Was the soil absorption system part of the evaluation?{s 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 evaluation):of the <br /> • Absorption distribution ['Equal ❑Serial ❑Pressure [qual via pressure <br /> • Absorption lines construction material: <br /> ❑ Gravel and pipe ❑ Chamber ❑Tile ❑Polystyrene foam and pipe ❑Other <br /> • Absorption distribution unit(s): ❑dropbox[iydrosplitter❑equal distribution box <br /> Efntact ❑Damaged ❑N/A <br /> • Absorption distribution unit(s)are free of debris or solids s ENo ❑N/A <br /> Page 4 of 8 <br />