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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❑Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition ❑Yes ❑No <br /> • Dosing tank lid is intact ❑Yes ['No <br /> • Electrical components are sealed and watertight ❑Yes ❑No <br /> • Pump/siphon is functional Eyes ❑No <br /> • Type of Pump EDemand dose ['Time dose <br /> • Pump control mechanism is functional(floats,pressure transducer)Eyes ❑No <br /> • There is a high water alarm Oyes ❑No <br /> • The high water alarm(audible and visual)is working Oyes ❑No ❑Not Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris Eyes ❑No-Screen cleaned for this evaluation Dyes ONO <br /> • Scum/sludge present in Dosing tank Oyes ❑No <br /> • 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 ❑Unknown <br /> • Was the soil absorption system part of the evaluation?®Yes ❑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 /> • Absorption distribution ZEqual ESerial ❑Pressure ❑Equal via pressure <br /> • Absorption lines construction material: <br /> ❑Gravel and pipe ❑ Chamber Tile ❑Polystyrene foam and pipe ❑Other <br /> • Absorption distribution unit(s): ❑dropbox❑hydrosplitter equal distribution box <br /> ❑Intact ❑Damaged L1 N/A <br /> • Absorption distribution unit(s)are free of debris or solids Oyes ❑No N/A <br /> Page 4 of 8 <br />