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• <br /> 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 Yes <br /> • No <br /> * Dosing tank lid is intact Yes ? No <br /> * Electrical components are sealed and watertight 'Ye5 No <br /> * Pump/siphon is functional :Yes 'No <br /> * Type of Pump <br /> Demand dose . Time dose <br /> * Pump control mechanism is functional(floats,pressure transducer) • Yes <br /> 'No <br /> * There is a high water alarm ;Yes No <br /> * The high water alarm(audible and visual)is working Yes <br /> . - No Not Applicable <br /> * Type of screen <br /> * Screen is clean-and free of debris Yes ' No <br /> * Screen cleaned for this evaluation <br /> Yes No <br /> * Scum/sludge present In Dosing tank Yes 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? <br /> If the soil absorption system was not evaluated,please explain below(foer example unable to locate,s No clientt did nonote t <br /> tes <br /> authorize this part of the evaluation): <br /> * Absorption distribution Equal x Serial Pressure Equal via pressure <br /> * Absorption lines construction material: <br /> Gravel and pipe x Chamber Tile Polystyrene foam and pipe Other <br /> * Absorption distribution unit(s): x -dropbox hydrosplitter equal distribution box <br /> x Intact Damaged N/A <br /> * Absorption distribution unit(s)are free of debris or solids x Yes No N/A <br /> Page 4 of 8 <br />