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breg.en'Department of Erivi .ninmantal <br /> • Dosing tank rapacity (gallons) <br /> • Tank volume determined by:Check all that apply,add comments below as needed <br /> Permit lizards 0 Measured 0 Stainped on Tank <br /> • Dosing tank material <br /> • Dosing tank.appeari to:be watertight and lir good conditiorr Oyes DNO <br /> • Dosing tank lid is intact Dyes Olio <br /> •• Electrical components are sealed and watertight E]Yes (3No <br /> * Pump/Siphon is functional [-Yes Ell‘lo <br /> Type ofPurnp, CJDemand dose Dime dose <br /> • Pturip control Mechanism is functional(floats,press re traits' diicer)DYes ONo <br /> • There lair high Water alarm[Nes ONO <br /> • The high water alarm(audible and-visual)ii:Working DYes ONO Elia Applicable <br /> • Type-Ofsr.reen <br /> • • Screen is Cleamand-free of debrii0YeS ENO Screeri'clearied for this evaluation Dyes ONe <br /> • ScurtifSlUdge preset in Dasirig tank OYes 12No <br /> • Scum layer (inches) Sludge layer (inches) <br /> • Additional Cornments: — - - <br /> -.. 5. Soil absorptinitSyStel - <br /> The soil absorption system is a set oftrenches that receives effluent from the septic tank and <br /> filters the effliient before it enters the groundwater. <br /> • The"saiiffic'sYstaiit has a soil absorption system)7,Yes 12No OUnknown <br /> • Wakthe.soif,abserption system part oftheevaluation?1274est'tillo DSee note below <br /> If the soil,absorption system was not evaluated,please explain below(fur example unable to <br /> Jocateclientilid not authorize this part: ofthe evaluation): <br /> • Absorption distribution.: DEqual ElSetial [Pressure DEqUal via pressime <br /> • Absorption lines construction material: <br /> [3-Gravel and pipe 1::1 Chamber 0 Tile 0 Polystyrene foam and pipe I:CO.11er <br /> • Absorption distribution unit(s):(31ropbox Ohydrosplitter Dequal distribution box <br /> E1 Intact 0 II-Imaged N/A <br /> • Absoritfon distribittieri iniii(Sjirri free Of debris or solids 'ElY ONO <br /> Pe4e 4 Of S <br />