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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 x Measured Stamped on Tank Other <br /> * Dosing tank material CONCRETE <br /> * Dosing tank appears to be watertight and in good condition x Yes No <br /> * Dosing tank lid is intact x Yes No <br /> * Electrical components are sealed and watertight x Yes No <br /> * Pump/siphon is functional x Yes No <br /> * Type of Pump x Demand dose I I Time dose <br /> * Pump control mechanism is functional(floats,pressure transducer) x Yes No <br /> * There is a high water alarm x Yes No <br /> * The high water alarm(audible and visual)is working x Yes No Not Applicable <br /> * Type of screen <br /> * Screen is clean and free of debris x Yes nVo <br /> * Screen cleaned for this evaluation x Yes No <br /> * Scum/sludge present in Dosing tank x Yes No <br /> * Scum layer 0 (inches) Sludge layer 2 (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 No x Unknown <br /> * Was the soil absorption system part of the evaluation? Yes n No t I See note below <br /> If the soil absorption system was not evaluated,please explain below(for example unable to locate,client did not <br /> authorize this part of the evaluation): <br /> CUSTOMER DID NOT AUTHORIZE. <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 hydrosplitter equal distribution box <br /> 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 />