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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 /> 0 Permit Records El Measured El Stamped on Tank 0 Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition I0Yes ONO <br /> • Dosing tank lid is intact DYes. ONo <br /> • Electrical components are sealed and watertight DYes ONo <br /> • Pump/siphon is functional DYes ONo <br /> • Type ofPump Elbemand dose 0Tiine dose <br /> • Pinup control mechanism,is functional(floats,pressure transducer)0Yes ONo <br /> • There is a high water alarm DYes ONo <br /> • The high water alarm(audible and visual)is working DYes ONO :Not Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris DYes DNo-Screen cleaned for this evaluation DYes 0No <br /> • Scum/sludge present in Dosing tank ['Yes ONo <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 bfotI it enters the groUndwater. <br /> .• The septic system has a soil absorption system[EYes 0No DUnknown <br /> • Was the soil absorption system part of the evaluation'? es ONo. ['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 IDSerial ['Pressure ['Equal via pressure <br /> • Absorption lines construction material: <br /> 9Gravel and pipe 0 Chamber 0 Tile 0 Polystyrene foam and pipe 00ther <br /> • Absorption distribution unit(s) Ddropbox Ohydrosplitterylequal distribution box <br /> Intact 0 Damaged El N/A <br /> • Absorption distribution imit(s)are free of debris or solids DYes ONo N/A <br /> Page.4 of 8 <br />