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iStrk( <br /> 4 <br /> Oregon Department of Environmental Quality <br /> a Dosing tank capacity (gallons).. <br /> Thnk volume de/embed by:Check all that apply,add comments below as needed <br /> 0 Permit Records 0 Measured D Stamped on Teak 0 Other <br /> • Dosing Mak: <br /> * Dosing tank appears to be watertight and in good condition Dyes DNo <br /> • Dosing tank lid is intact DYes DNo <br /> • Electrical components are sealed and watertight Dyes IINo <br /> • Pump/siphon is functional bYes DD' <br /> • Type of Pump dose (]Time dose <br /> • Pump control mechanism is functional(floats,pressure'transducer)DYes DNo <br /> • There is a high water alarm DYes [DNo <br /> • The high water alarm(audible and visual)is wading. Oyes DNo DNotApplicable <br /> • Type ofsemen <br /> s Screen is clean and free of debris DYes DNo-Screen cleaned for this evaluation DYes DNo <br /> • Scum/sludge present inDosing task DYes []No <br /> • Scum layer (inches) Sludge layer (inches) <br /> • Additional Comma <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 groundwatet <br /> • The septic system has a soil absorption system IYes DNo DUnknown <br /> • Was the soil absorptionsystem abeorpricasystem part of theevaluation?'IYes DNo 05cc 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€evaluattorr):. <br /> • Absorption distribution ['Serial DPressura <br /> Ovia pressure <br /> • Absorption lines construction material; <br /> Gravel and pipe 0 Chamber 0 Tile 0 Pcdystynme foam and pipe Doper' <br /> • Absorption distribution unit(s):Ddropbox Ohydrosplitter`Kequal distribution box <br /> J Intact D Damaged D N/A <br /> • Absorption distribution unit(s)are free of debris or solids XYes END D N/A <br /> Page 4 of 8 <br />