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• <br /> • <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 [Nes ❑No <br /> • Dosing tank lid is intact ❑Yes No <br /> • Electrical components are sealed and watertight fYes ENO <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 No <br /> • The high water alarm (audible and visual)is working ❑Yes No ❑Not Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris❑Yes ❑No-Screen cleaned for this evaluation EYes ❑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 11,0 s ['No ['Unknown <br /> • Was the soil absorption system part of the evaluation? s No ❑See note below <br /> Ifthe 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 /> • Absorption distribution ual ❑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 [kto ❑N/A <br /> Page 4 of 8 <br />