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Oregon Department of Environmental Quality <br /> • Dourtg tank capacity (gallons) <br /> • Tank volume determined by:Check all that apply,add comments below as needed, <br /> Permit Records Measured Stamped on Tank 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 No <br /> • Electrical components are seated and watertight Yes No <br /> * Pump/siphon is functional Yes No <br /> • 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 Yes No <br /> • The high water alarm(audible and visual)is working Yes No Not Applicable <br /> • Type of screen <br /> { <br /> * Screen is clean and free of debris Yes No <br /> Screen cleaned for this evaluation Yes No <br /> • Scum/sludge present In Dosing tank Yes No <br /> • Scum layer (inches) Sludge layer (inches) <br /> * Additional Comments: <br /> 5. Soil absorption system <br /> 1 The soil absorption system Is a set of trenches that receives effluent from the septictattkarttd <br /> filters the effluent before it enters the groundwater. <br /> ( <br /> • The septic system has a soil absorption system x Yes No Unknown <br /> • Was the soil absorption system part of the evaluation? X Yes No See note below <br /> If the soil absorption system was not evaluated,please explain below(for example unable to locate,client did not <br /> authorize this part of the evaluation): <br /> * Absorption distribution x Equal Serial Pressure Equal via pressure <br /> • Absorption lines construction material: <br /> x Gravel and pipe Chamber Tile Polystyrene foam and pipe Other <br /> • Absorption distribution unit(s): dropbox hydrosplitter equal distribution box <br /> Intact Damaged x N/A <br /> * Absorption distribution unit(:)are free of debris or solids Yes No x NjA <br /> _``. Page 4 at <br />