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Oregon Department of Environmental Quality <br /> • Dosing tank capacity 500 (gallons) <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit Records m Measured 0 Stamped on Tank 0 Other <br /> • Dosing tank material COncrete <br /> • Dosing tank appears to be watertight and in good condition ®Yes DNo <br /> • Dosing tank lid is intact ®Yes ONo <br /> • Electrical components are sealed and watertight ®Yes ONo <br /> • Pump/siphon is functional DYes ONo unknown,no power <br /> • Type of Pump ®Demand dose [rime dose <br /> • Pump control mechanism is functional(floats,pressure transducer)DYes ONo <br /> • There is a high water alarm DYes ®No <br /> • The high water alarm(audible and visual)is working DYes ONo ®Not Applicable <br /> • Type of screen Cage Screen <br /> • Screen is clean and free of debris®Yes ONo-Screen cleaned for this evaluation®Yes DNo <br /> • Scum/sludge present in Dosing tank ®Yes DNo <br /> • Scum layer 0 (inches) Sludge layer 1 (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 DNo DUnknown <br /> • Was the soil absorption system part of the evaluation?®Yes DNo ['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 OSerial ['Pressure ®Equal via pressure <br /> • Absorption lines construction material: <br /> ®Gravel and pipe ❑Chamber 0 Tile ❑Polystyrene foam and pipe ['Other <br /> • Absorption distribution unit(s):Ddropbox Dhydrosplitter['equal distribution box <br /> ❑Intact ❑Damaged WI N/A <br /> • Absorption distribution unit(s)are free of debris or solids ['Yes ONo®N/A <br /> Page 4 of 8 <br />