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s <br /> Oregon Department of Environmental Quality <br /> • Dosing tank capacity (gall° s) <br /> • Tank volume determined by: Check all at apply,add comments below as needed <br /> ❑Permit Records ❑Measured❑ St mped on Tank❑ Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight in good condition ❑Yes ❑No <br /> • Dosingtank lid is intact Yes N <br /> ❑ ❑ <br /> i Y <br /> • Electrical components are sealed and w tertight ['Yes ENo <br /> • Pump/siphon is functional [Nes ❑No <br /> • Type of Pump ❑Demand dose Win e dos <br /> • Pump control mechanism is furled( 11 'float ,pr ssure transducer)❑Yes No <br /> • There is a high water alarm❑Ye. 111N° <br /> • The high water alarm(audible and visu 1)is working ❑Yes ❑No ❑Not Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris❑Y s ❑No-Screen cleaned for this evaluation❑Yes ❑No <br /> • Scum/sludge present in Dosing tank ❑Yes Elio <br /> • Scum layer (inches) S dge 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 ENo ❑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 distribution11( <br /> al ❑Serial :Pressure Equal via pressure <br /> • bsorption lines construction material: <br /> Gravel andPiP e ElChamber ElTile ❑Polystyrene foam and ' ❑Other <br /> • Absorption distribution unit(s): ❑dropbox nhydrosplitter equal distribution box <br /> 10 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 />