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Oregon Department of Environmental Quality <br /> e Dosing tank capacity (gallons) <br /> • Tank volume determined by:Check all that apply;add confluents below as needed <br /> Permit Records❑Measured F`Stamped`on Tank❑Other <br /> ® DoSitng tank material <br /> • Dosing tank appears to be watertight and in good condition [Yes ❑No <br /> © Dosing tank lid is.intact DYes ❑No:. <br /> ® Electrical components are sealed and watertight ❑Yeso <br /> • Pump/siphon is functional DYes ❑No <br /> o Type of Pump ❑Demand dose OTime dose <br /> d Pump control mechanists is functional(floats;pressure transducer)DYes ❑No <br /> • There is a high water alarm DYes ❑No. <br /> m The high water alarm(audible and visual)isworkinn ❑Yes ❑?Lo ❑Not.Applicabie: <br /> o Type of screen <br /> • Screen is clean and free of debris DYes ❑No-Screen cleaned for this evaluation DYes ❑No <br /> o Scum/sludge present in Dosing tank DYes ❑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 on system.(fir ,s No L_t'l ❑ ❑ Jnknown <br /> • Vas the soil absorption system part of the evaluation? es ❑No ❑See note below <br /> If the soil absorption system was not evaluated,please explain:below(for example unable to <br /> locate,client did not aut(orize this part of the evaluation): <br /> • Absorption distribution MI-qua! 0 Serial [-Pressure DEqual via pressure <br /> ® sorption lines construction material: <br /> Gravel andpipe ❑Chamber Q Tile D. �u <br /> Polystyrene foa .and pipe ❑Uthei- <br /> icbs <br /> orption distribution unit(s): +❑dropbo ❑hydrosplitterDe-- <br /> " equal •distribution box <br /> Intact ❑!Damaged Li N/A <br /> • Absorption distribution unit(s):are free of debris or solids , .;Yes 0No❑WA <br /> Page 4.of 8 <br /> I. <br />