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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 /> 1 Permit Records Measured Stamped on Tank Other <br /> * Dosing tank material <br /> * Dosing tank appears to be watertight and in good condition Yes No <br /> * Dosing tank lid is intact YesNo <br /> * Electrical components are sealed and watertight Yes No <br /> * Pump/siphon is functional Yes !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 ;Yes I No <br /> * The high water alarm(audible and visual)is working Yes NoNot Applicable <br /> * Type of screen <br /> * Screen is clean and free of debris Yes iNo <br /> * Screen cleaned for this evaluation Yes No <br /> * Scum/sludge present in Dosing tank � Yes 1 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 x Yes `No Unknown <br /> * Was the soil absorption system part of the evaluation? x Yes No , 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 /> * Absorption distribution x Equal ;Serial Pressure 'Equal via pressure <br /> * Absorption lines construction material: <br /> x Gravel and pipe Chamber Tile Polystyrene foam and pipe Other <br /> * Absorption distribution unit(s): dropbox hydrosplitter x equal distribution box <br /> x •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 />