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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 /> o Dosing tank appears to be watertight and in good condition ❑Yes ❑No <br /> O Dosing tank lid is intact ❑Yes ❑No <br /> © Electrical components are sealed and watertight ❑Yes ❑No <br /> e Pump/siphon is functional ❑Yes ❑No <br /> • Type of Pump ❑Demand dose ['Time dose <br /> O Pump control mechanism is functional(floats,pressure transducer)❑Yes ❑No <br /> ® There is a high water alarm['Yes ❑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 /> ® 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 systemYes ❑No ❑Unknown <br /> ® Was the soil absorption system part of the evaluation?❑Yes Ec No , See note below <br /> If the soil absorption system was not evaluated, please explain below(for example unable to <br /> locate client did <br /> not authorize this part of the evaluation):), <br /> `4YL:_ �1 Ir'� oNi n 4-ov .”--- Cd, oD5 4 &* <br /> ® Absorption distribution ❑Equal ❑Serial ❑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 ❑N/A <br /> ® Absorption distribution unit(s)are free of debris or solids ❑Yes ❑No ❑N/A <br /> Page 4 of 8 <br />