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Oregon Department of Environmental Quality <br /> O Dosing:tank capacity (gallons), <br /> , <br /> • Tank volume determined by Check all that apply,add comment,-below as needed <br /> 0 Permit Records 0 Measured:0 Stamped on Tank Other <br /> • Dosing-tank material <br /> 4 Dosing.tank appears to:be watertight and in good condition E j-Yes ONO <br /> Dosingtank lid is intact Dyes: .014o <br /> • Electrical couipOnenis are sealed and watertight °Yes DN <br /> 9 Puinp/siphon is functional Lilies 0No <br /> 9 Type of Pump 0Demand dose ElTime dose <br /> • Pump control mechariisin is'functional(floats,pressuretrarisducer)Dares Obi° <br /> • There is a hi.O.water,arwm FlYes Ol\ro <br /> 0 The high water alarm(audible and visual)is working L_Ples ONo EINot Applicable <br /> • Type of screen, <br /> ▪ Screen:is clean and free of debris DYes. -Screen cleaned for this,evaluation'0Yes f:11\ro <br /> 9 Scum/sludge present in-Dosing tank Oyes LJNo <br /> * Senor layer (inches) Sludge layer (inches) <br /> • Additional Comments: <br /> 5. Soil absorption system <br /> The soil absorption system isa set of trenches that receives effluent from the septic tank and <br /> filters the effluent before it enters the groundwater.. <br /> 0 The septic system has a SOH absorption system Mye..s 01.4. o jr-iUnkn' (.3wn <br /> • Was the soil absorption system pad of The evaluation?:Wves DNo OSe.e note below <br /> If the soil absorption system was not evaluated,please explain below(for example unable to <br /> locate,client did notanthorize this part fthe evaluation): <br /> „ . <br /> F <br /> Absorption distibution Oqual Nsertat. Pressure E3Equal via pressure' <br /> Absorption lines constructl'on rnaterial: <br /> [1E1 Gravel and pipe. 0 Chamber 0 Tile 0 Polystyrene foant and pipe LOther <br /> Absorption distribution unit(s):Irdropbox Elydrosplitter De..qual cliStribution box <br /> , intact Damaged CI NIA <br /> O Absorption diStribirtion links)are free of debris or solids El Yes ErNo Di /A <br /> Page 4-of 8 <br />