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• Oregon Department of Environmental Quality • • Dosing tank capacity _(gallons) • Tank volume determined by:Check all that apply,add comments below as needed ❑Permit Records❑Measured I❑Stamped on Tank❑Other • Dosing tank material • Dosing tank appears to be watertight and in good condition DYes ❑No . • Dosing tank lid is intact DYes ❑No • • Electrical components are sealed and watertight DYes ❑No • . Pump/siphon is functional DYes ❑No .• Type of Pump ❑Demand.dose DTime dose . • Pump control mechanism is functional(floats,pressure transducer)DYes ❑No . • • There is a high water alarm DYes ❑No • The high water alarm(audible and visual)is working DYes ❑N.o '❑NotApplicable • Type of screen • • Screen is clean and free of debris DYes ❑No-Screen cleaned for this evaluation DYes ❑No • Scum/sludge present in Dosing tank DYes ONo • Scum layer (inches) Sludge layer (inches) • • Additional Comments: • 5. Soil absorption system • . , The soil absorption system is a set of trenches that receives effluent from the septic tank and • filters the effluent before it enters the.groundwater. . • The septic system has a soil absorption system KlYes DNo DUnknown • • *Was the soil absorption system part of the evaluation?JYes ❑No ❑See note below' If the soil absorption system was not evaluated,please explain below(for example unable to locate,client did not authorize this part of the evaluation): , • -Absorption distribution %Equal ❑Serial ❑Pressure DEqual via pressure • Absorption lines construction material: • 0 Gravel and pipe ❑Chamber ❑Tile ❑Polystyrene foam and pipe DOther • Absorption distribution unit(s):Ddropbox❑hydrosplitterequal distribution box. '1 V Intact ❑Damaged ❑N/A • Absorption distribution unit(s)are free of debris or solids Wes. ❑No❑N/A Page 4 of 8 .