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Oregon Department of Environmental Quality <br /> • Dosing tank capacity 1,000 (gallons) <br /> • Tank volume determined by: Check all that apply,add comments below as needed <br /> Permit Records 0 Measured 0 Stamped on Tank❑Other <br /> • Dosing tank material �Q n G <br /> • Dosing tank appears to be watertight and in good condition NYes ❑No <br /> • Dosing tank lid is intact NlYes ❑No <br /> • Electrical components are sealed and watertight Yes ❑No <br /> • Pump/siphon is functional Wes ❑No <br /> • Type of Pump NiDemand dose ❑Time dose <br /> • Pump control mechanism is functional(floats, pressure transducer)'Yes ❑No <br /> • There is a high water alarm Wes ❑No <br /> • The high water alarm(audible and visual)is working [X]Yes ❑No ❑Not Applicable <br /> • Type of screen tArAk <br /> • Screen is clean and free of debris❑Yes NINo-Screen cleaned for this evaluation IYes ❑No <br /> • Scum/sludge present in Dosing tank EXTYes ❑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[iYes ❑No ❑Unknown <br /> • Was the soil absorption system part of the evaluation?[ Yes ONo ['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 Merial ❑Pressure ❑Equal via pressure <br /> • Absorption lines construction material: <br /> U] Gravel and pipe ❑Chamber ❑Tile ❑ Polystyrene foam and pipe ❑Other <br /> • Absorption distribution unit(s): igdropbox Ohydrosplitter❑equal distribution box <br /> X Intact 0 Damaged 0 N/A <br /> • Absorption distribution unit(s)are free of debris or solids [ Yes ❑No ❑N/A <br /> Page 4 of 8 <br />