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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 /> ❑-Permit Records 0 Measured 0 Stamped on Tank.E.Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition DYes DNo: <br /> • Dosing tank lid is intact DYes ONo <br /> • Electrical components are sealed and-watertight ['Yes: ONo <br /> • Pump/siphon is,functional ['Yes ONo <br /> • Type of Pump ['Demand dose ['Time dose <br /> • Pump control mechanism isfunctional(floats,pressure transducer)['Yes ONo <br /> • There is.a high water alarm DYes ONo <br /> • The high water.alarm(audible and visual)is working Dyes: DNo DNot Applicable <br /> • Type of screen <br /> •. Screen is clean and free of debris,['Yes 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 front the septic tank and <br /> filters the effluent before it enters the groundwater. <br /> • The septic system has a soil absorption system piles ['No ['Unknown <br /> • Was the soil absorption system part ofthe evaluation?JYes DNo DSee 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 cglEquat ['Serial ['Pressure ['Equal via pressure <br /> • Absorption lines construction material: <br /> Fi.Gravel and pipe [':'Chamber 0 Tile 0 Polystyrene foam and pipe DOther <br /> • Absorption distribution wit(s) Ddropbox Dhydrosplitter equal distribute on box <br /> g Intact ['Damaged 0 NIA <br /> • Absorption distribution.unit(s)"are free of debris or solids )Yes ['No O N/A <br /> Page 4 of 8 <br />