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Oregon-Department of Environmental Quality <br /> !! I <br /> ! 4: Dosing tank capacity (gallons) <br /> 1 .. Tank volume:determined by:Check all that apply,add comments below as needed <br /> 1 <br /> 0'Permit Records 0 Measured El.Smped on Tank 0 Other <br /> •• Dosing tank-material <br /> • Dosing tank appears to be watertight and in good condition Eyes ONO <br /> 1 • Dosing tank lid is.intact .Elves ONO <br /> Electrical components are-sealed-and watertight OYes ,EINo <br /> Putnpisiphon is functional 0Yes ONo <br /> • Type of Pump Oben-land dost 0Titne dose <br /> Pump control mechanism is functional(floats,pressure transducer)0Ves '0No <br /> 1 <br /> • There is a high water alarm ElYes 0No <br /> 4 <br /> 8 The high water alarm(audible and visual)Is working CIYes 11111\To ONotApplicable <br /> • Type of screen <br /> 1 • Screen is clean and free of debris L[Yes LINo-Screen cleaned for this evaluation 0Yes flNo <br /> •• Scum/sludge,present in:Dosing-tank 0Yes [No <br /> • .SCUIII layer (inches) Sludge layer (inches) <br /> • Additional Comments: <br /> 5. Soll absorption system <br /> The soil absorption system is a set of'trenches that receives effluent from the Septie tank and <br /> filters the effluent befOre it enters the groundwater. <br /> S. The septic Systemhas a soil absorption system EYes flio OUnlmoWn <br /> • Was the soil'absorption system part of the evaluation l ElYes fR]No Elsee note below <br /> If the soil absorption system was not evaluated,please explain below(for example unable to <br /> locate,client.clidnot authorize this:part of the evaluation): <br /> .5e.coke Ly4i4.4'..e.„.*Ey.sAL r`124x he,s <br /> ltlemt.41 ,15 <br /> Absorption distribution ['Equal 0Setial [Pressure 0Equal via pressure <br /> :0 Absorption lines construction material: <br /> 0 Gravel and pipe 0 Chamber El.Tile 0 Polystyrene foam and pipe- Dottier <br /> Absorption distribution wigs):Ddropbox Ohydrosplitter.DeqUal distribution box <br /> 0 Intact n Damaged El N/A <br /> Absorption distribution sunit(s)are free of debris or solids Eyes 0No El WA. <br /> Page 4 of 8 <br /> 1 <br />