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Oregon Department of Environmental Quality <br /> • Dosing tank capacity 5(50 (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 C,Of1, <br /> • Dosing tank appears to be watertight and in good condition EYes ❑No <br /> • Dosing tank lid is intact Ef Yes ENo <br /> • Electrical components are sealed and watertight iYes No <br /> • Pump/siphon is functional [ Yes ❑No <br /> • Type of Pump ODemand dose ['Time dose <br /> • . Pump control mechanism is functional (floats, pressure transducer) ;.4Yes No <br /> • There is a high water alarm.NYes. No <br /> • . The high water alarm ib(audible and <br /> "visual)is working (I ❑Yes No ['Not Applicable <br /> 4J �1• Type of screen U O <br /> • Screen is clean and free of debris❑Yes CdNo- Screen cleaned for this evaluation Iti Yes ❑No <br /> • . Scum/sludge present in Dosing tank Yes ['No <br /> • Scum layer 0 (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 1�Yes ❑No ['Unknown <br /> • Was the soil absorption system part of the evaluation?[Wes ❑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 of the evaluation):. <br /> • Absorption distribution ►►:Equal ['Serial ❑Pressure Equal via pressure <br /> • Absorption lines construction material: <br /> Gravel and pipe ❑ Chamber ❑ Tile ❑Polystyrene foam and pipe ❑Other <br /> • Absorption distribution unit(s): ❑dropbox❑hydrosplitterWequal distribution box <br /> NI Intact ❑ Damaged ❑N/A <br /> • Absorption distribution unit(s) are free of debris or solids Yes •[No ❑N/A <br /> Page 4 of 8 <br />