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. . . :: • • •: .• : . : : • • ••: : •• • 11 ;;;; :1] E: 1: 11 : Oregon Department of Environmental Quality • :: : E:E • • •• - •-• • •• .. • . . . . . . • • • Dosing tank capacity (gallons) . . . . . • - !! !! !! ! • Tank volume determined by: Cheek all-that apply,add comments below as needed 0 Permit Records Measured 0 Stamped on Tank 0 Other . . .. . • • Dosing tank material • Dosing tank appear's.to be watertight and in good condition :[:=1Yes. 0No • Dosing tank lid is intact: ['Yes [No . . . . • Electrical components are sealed and watertight [j]Yes. 0No • „. . . . Pump/siphon is functional 0Yes DNOI • • • Type of Pump;;;;['Penland dose OTime dosel; . „ •;; Pump Control illecham.Sin is functional(floats,pressure transducer)0Yes 0No •: There is a high water alarm 0Yea [No:: 1: • The high water alarm(audible and visual)is working 0YeS 0No 0Not Applicable • Type of screen: • Screen is clean andl free of debris 0Yes ONO:-Screen cleaned for this evaluation DYes [INo • Scum/sludge present in Dosing tank ['Yes ONO : • Scum layer (inches) ! Sludge (inches) - • . . . " Additional Cornments:;i • •: •:: ••• • • • •• • • . . . • • • • • . . . . . . . . . . . . . • ••• • ••• - • 5 Soil absorption system . . . . . . . . The soil absorption system is a set of trenches that receives effluent from the septic tank and filters the effluent before it enters the groundwater. : • • The septic system has a!soil absorption system Wes EINo DUnknOwn • Was the soil absorption system part of the evaluation?0YeS .rdlNo 0See not below : , • ••• ••• " " " " " , • •• •• • :: If the soil absorption system was not evaluated,please explain below(for example unable to . . . . . . . . . locate,client did not authorize this part of the evaluation) • !i. ,a, ,,, •, ,• • Absorption distribution ['Equal!:['Serial 0Pressure DEqual via pressure !! „. , . . . •:: Absorption aids construction material: . . . . . . O Gravel and pipe 0 Chamber D Tile D Polystyrene foam and pipe 00ther ::: • •• :• : •;: AbsorptiOn distribution unit(s): DdrO.PboX OhydrOsplitter Dequal distribution box 0 Intact!ID Damaged i Eli N/A : - • . . • •• • . . • Absorption distribution unit(s)are free of debris or solids 0Yes 0No 0 N/A •• •• • •• •• • . . . . . . . . :! !: Page 4 of 8 . . . . . . . . • • •• •• : . . . . • • .• • • . . . . . . .. . . . . . . . . . . . . . - • •