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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 n Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition ❑Yes ❑No . <br /> • Dosing tank lid is intact DYes ❑No <br /> • Electrical components are sealed and watertight ❑Yes ❑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)❑Yes ❑No <br /> • There is a high water alarm❑Yes [I]No <br /> • The high water alarm(audible and visual)is working ❑Yes ❑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 /> e 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 DUnknown <br /> • Was the soil absorption system part of the evaluation?pYes ❑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 /> O Absorption distribution DEqual [Serial ❑Pressure nEqual via pressure <br /> o Absorption lines construction material: <br /> ElGravel and pipe Chamber ❑Tile n Polystyrene foam and pipe ['Other <br /> • Absorption distribution unit(s): dropbox nhydrosplitter Elequal distribution box <br /> pint= ❑Damaged ❑N/A <br /> e Absorption distribution unit(s)are free of debris or solids Yes ❑No ❑N/A <br /> • <br /> Page 4 of 8 <br />