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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 /> El Permit Records❑Measured❑ Stamped on Tank El Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition EYes ❑No <br /> • • Dosing tank lid is intact DYes ❑No <br /> o Electrical components are sealed and watertight ['Yes [No <br /> • Pump/siphon is functional DYes ❑No <br /> • Type of Pump ❑Demand dose ❑Tune dose <br /> • Pump control mechanism is functional(floats,pressure transducer)DYes ❑No <br /> • There is a high water alarm DYes ❑No <br /> e The high water alarm (audible and visual)is working [1]Yes ❑No fNot 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 /> m 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 ['Unknown <br /> • Was the soil absorption system part of the evaluation?®Yes ❑No OSee 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 /> • <br /> • Absorption distribution ©Equal ['Serial ['Pressure ❑Equal via pressure <br /> • Absorption lines construction material: <br /> ® Gravel and pipe El Chamber ❑Tile ❑Polystyrene foam and pipe ❑Other <br /> • Absorption distribution unit(s):❑dropbox❑hydrosplitter Dequal distribution box <br /> l 'Intact ®Damaged ❑N/A— �`�r e„d 11 S 1 `41 <br /> • Absorption distribution unit(s)are free of debris or solids ❑Yes No ❑N/A <br /> Page 4 of 8 <br />