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• <br /> Oregon Department of Environmental Quality <br /> • Dosing tank capacity (gallons) <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> D Permit Records.0 Measured 0 Stamped on Tank 0 Other <br /> • Dosing tank material <br /> •. Dosing tank appears to be watertight and in good condition Dyes [No <br /> • Dosing tank lid is intact []Yes .DNo <br /> • Electrical components are sealed and watertight Dyes DNo <br /> • Pump/siphon is functional []Yes [No <br /> • Type.of Pump []Demand dose [Time dose <br /> • Pump control mechanism is functional(floats,pressure transducer)0Yes DNo <br /> • There is a high water alarm[]Yes DNo <br /> • . The high water alarm(audible and visual)is working []Yes ONo [Not Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris[Yes [No-Screen cleaned for this evaluation[]Yes ONo <br /> • Scum/sludge present in Dosing tank []Yes ONo <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[Yes DNo []Unknown <br /> • Was the soil absorption system part of the evaluation?Wes DNo [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 VEqual ['Serial []Pressure [Equal via pressure <br /> • Absorption Iines construction material:. <br /> riti Gravel and pipe 0 Chamber 0 Tile 0 Polystyrene foam and pipe ❑Other <br /> • Absorption distribution unit(s): Ddropbox[]hydrosplitter Requal distribution box ' <br /> 0 Intact 0 Damaged 0 N/A <br /> • Absorption distribution unit(s)are free of debris or solids JYes ONo❑N/A <br /> Page 4 of 8 <br />