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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❑Measured❑Stamped on Tank❑Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition DYes ❑No <br /> • Dosing tank lid is intact DYes ❑No <br /> • Electrical components are sealed and watertight Dies ❑No <br /> • Pump/siphon is functional DYes ❑No <br /> • Type of Pump ['Demand dose ❑Time dose <br /> • Pump control mechanism is functional (floats,pressure transducer)['Yes ❑No <br /> • There is a high water alarm DYes ❑No <br /> • The high water alarm(audible and visual)is working ['Yes ❑No ❑Not Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris DYes ❑No-Screen cleaned for this evaluation Dyes ❑No <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 from the septic tank and <br /> filters the effluent before it enters the groundwater. <br /> • The septic system has a soil absorption system Eyes ❑No ['Unknown <br /> • Was the soil absorption system part of the evaluation? Yes ❑No ['See note below <br /> lithe 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 pEqual ['Serial ['Pressure ❑Equal via pressure <br /> • Absorption lines construction material: <br /> no,'Gravel and pipe ❑Chamber ❑Tile ❑Polystyrene foam and pipe DOther <br /> • Absorption distribution unit(s):Ddropbox❑hydrosplitter equal distribution box <br /> 72 Intact ❑Damaged ❑N/A <br /> • Absorption distribution unit(s)are free of debris or solids DYes EpNo❑N/A <br /> Page 4 of 8 <br /> 2 Gc� 1VL 1Z<r,�v tn,L <br />