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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 /> ❑ 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 ❑Yes ❑No <br /> • Electrical components are sealed and watertight nYes ❑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) nYes nNo <br /> • There is a high water alarm ❑Yes TNo <br /> • The high water alarm(audible and visual)is working nYes ❑No ['Not Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris ['Yes ❑No -Screen cleaned for this evaluation['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 ['Yes ❑No ❑Unknown <br /> • Was the soil absorption system part of the evaluation? nYes ❑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 authorize this part of the evaluation): <br /> • Absorption distribution ✓❑Equal ['Serial ❑Pressure DEqual 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 n Damaged ✓❑N/A <br /> • Absorption distribution unit(s) are free of debris or solids ['Yes ['No ✓❑N/A <br /> Page 4 of 8 <br />