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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 ['Yes []No <br /> • Type of Pump ['Demand dose ['Time dose <br /> • 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 ENO <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 system JYes ❑No ['Unknown <br /> • Was the soil absorption system part of the evaluation?NIYes ❑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 'a 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 /> Xi Intact ❑Damaged ❑N/A <br /> • Absorption distribution unit(s)are free of debris or solids IA.Yes ❑No❑N/A <br /> Page 4 of 8 <br />