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Oregon Department of Environmental Quality <br /> • Dosing tank capacity 56b (gallons) <br /> • Tank volume determined by: Check all that apply, add comments below as needed <br /> ig Permit Records❑ Measured❑ Stamped on Tank❑Other <br /> • Dosing tank material fib�U <br /> • Dosing tank appears to be watertight and in good condition i'4Yes No <br /> • Dosing tank lid is intact 4► Yes ONO <br /> • Electrical components are sealed and watertight Yes ❑No <br /> • Pump/siphon is functional glYes No <br /> • Type of Pump (E%/Demand dose ❑Time dose <br /> • Pump control mechanism is functional (floats, pressure transducer)21Yes No <br /> • There is a high water alarm NYes No <br /> • The high water alarm (audible and visual) is working AYes DNo ❑Not Applicable <br /> • Type of screen NI C5k <br /> • Screen is clean and free of debris DYes VjNo-Screen cleaned for this evaluation 1 Yes DNo <br /> • Scum!sludge present in Dosing tank //Yes ❑No <br /> • Scum layer d (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 71 Yes ❑No DUnknown <br /> • Was the soil absorption system part of the evaluation?DYes [g]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 DSerial DPressure Equal via pressure <br /> • Absorption lines construction material: <br /> ❑ Gravel and pipe ❑ Chamber ❑Tile ❑ Polystyrene foam and pipe DOther <br /> • Absorption distribution unit(s): ❑dropbox ❑hydrosplitter Equal distribution box <br /> ❑ Intact ❑ Damaged El N/A <br /> • Absorption distribution unit(s)are free of debris or solids DYes DNo❑N/A <br /> Page 4 of 8 <br />