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Oregon Department of Environmental Quality <br /> • Dosing tank capacity 500 (gallons) <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> ❑✓ Permit Records ❑ Measured n Stamped on Tank❑ Other <br /> • Dosing tank material Concrete <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 sealed and watertight n✓Yes ❑No <br /> • Pump/siphon is functional [—Wes ❑No <br /> • Type of Pump Demand dose ❑Time dose <br /> • Pump control mechanism is functional(floats,pressure transducer) ✓❑Yes nNo <br /> • There is a high water alarm n✓Yes [-No <br /> • The high water alarm(audible and visual) is working nYes ❑No ❑Not Applicable <br /> • Type of screen Bio screen <br /> • Screen is clean and free of debris❑✓Yes ❑No- Screen cleaned for this evaluation Yes ❑No <br /> • Scum/sludge present in Dosing tank ®Yes nNo <br /> • Scum layer 1 (inches) Sludge layer 3 (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 nNo ❑Unknown <br /> • Was the soil absorption system part of the evaluation?[Yes nNo ❑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 nEqual nSerial nPressure ❑Equal via pressure <br /> • Absorption lines construction material: <br /> ❑ Gravel and pipe ❑ Chamber ❑Tile ❑ Polystyrene foam and pipe ❑Other <br /> • Absorption distribution unit(s): ndropbox nhydrosplitter['equal distribution box <br /> ❑ Intact n Damaged ❑N/A <br /> • Absorption distribution unit(s)are free of debris or solids ❑Yes ❑No ❑N/A <br /> Page 4 of 8 <br />