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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 /> El 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 ONo <br /> • Dosing tank lid is intact. DYes ONo <br /> • Electrical cOmponents are sealed and watertight DYes Olklo <br /> • Pump/siphon is functional DYes ONo <br /> • Type of Pump ODemand dose OTime dose <br /> • Pump control mechanism is functional(floats,pressure transducer)Oyes [3No <br /> • There is a high water alarm DYes [JNo <br /> • The high water alarm(audible and visual)is working. DYes ONo [Not Applicable <br /> • Type a screen <br /> • Screen is clean and free of debris DYes ONo-Screen cleaned for this evaluation Dyes Do <br /> • Scum/sludge present in Dosing tank DYes DNo <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 groundwaterr. <br /> • The septic system has a soil absorption,system 0Yes [No OUnknown <br /> • Was the soil absorption,system part of the evaluation?DYes [ No [(See note below <br /> If the soil absorption system was not evaluated,please explairi below(for example unable to <br /> locate,client did not authorize,this part of the evaluation): <br /> PreAL-4.4.,0 VtoNS <br /> • Absorption distribution OEqual OSerial ['Pressure ['Equal via pressure <br /> • Absorption lines construction material: <br /> 0.Gravel and pipe 0.Chamber 0 Tile ID Polystyrene foam and pipe ['Other <br /> • Absorption distribution unit(s):Ddropbox Ohydrosplitter Oequal distribution box <br /> Intact 0 Damaged 0 N/A <br /> • Absorption distribution unit(s)are free of debris or solids DYes ONo 0 N/A <br /> Page 4 of 8 <br />