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Oregon Department of Environmental Quality <br /> e Dosing tank capacity (gallons) <br /> O Tank volume determined by:Check all that apply,add comments below as needed <br /> ❑Permit Records❑Measured❑Stamped on Tank❑Other <br /> o Dosing tank material <br /> o Dosing tank appears to be watertight and in good condition ❑Yes ❑No <br /> a Dosing tank lid is intact ['Yes ❑No <br /> o Electrical components are sealed and watertight ❑Yes ❑No <br /> © Pump/siphon is functional ❑Yes ❑No <br /> o Type of Pump ❑Demand dose ❑Time dose <br /> e Pump control mechanism is functional(floats,pressure transducer)❑Yes ❑No z,. <br /> o There is a high water alarm['Yes ❑No <br /> • The high water alarm(audible and visual)is working ❑Yes ❑No ❑Not Applicable <br /> e Type of screen <br /> o Screen is clean and free of debris❑Yes ❑No-Screen cleaned for this evaluation❑Yes ❑No <br /> e Scum/sludge present in Dosing tank ❑Yes ❑No <br /> O Scum layer (inches) Sludge layer (inches) <br /> o Additional Comments: s� <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 /> a The septic system has a soil absorption system 26"es ❑No ❑Unknown <br /> ‘L. <br /> e Was the soil absorptionpart of the evaluation? <br /> system ❑'S'es ❑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 /> e Absorption distribution ['Equal [. erial ❑Pressure ❑Equal via pressure <br /> e Absorption lines construction material: , <br /> 3?. <br /> 12r-6-ravel and pipe ❑Chamber ❑Tile ❑Polystyrene foam and pipe :Other <br /> O Absorption distribution unit(s): [1dropbox❑hydrosplitter❑equal distribution box <br /> ®'Intact ❑Damaged ❑N/A <br /> e Absorption distribution unit(s)are free of debris or solids 2fes ❑No❑N/A <br /> Page 4 of 8 <br /> Y 4;.i <br />