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Oregon Department of Environmental Quality <br /> • Dosing tank capacity U allons) <br /> • Tank volume determined by: Che all that apply, add comments below as needed <br /> ❑Permit Records❑Measure ❑ Stamped on Tank❑ Other <br /> • Dosing tank material <br /> • Dosing tank appears to be wate 'ght and in good condition ❑Yes No <br /> • Dosing tank lid is intact ❑Y s- ❑No <br /> • Electrical components are sealed and watertight ❑Yes ❑No <br /> • Pump/siphon is functional ❑Yes •No <br /> • Type of Pum p ❑Dem...'dose //Time <br /> • ec ' u ' . ' <br /> Pump control m hams i fun ional <br /> sure'transducer)❑Yes ❑No <br /> • There is a high water .1arm V, eso <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 debri ❑Yes ❑No-Screen cleaned for this evaluation❑Yes ❑No <br /> • Scum/sludge present in Dosing ank ❑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 ❑N Unknown <br /> • Was the soil absorption system part of the evaluation? Yes ❑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 ❑Equal al ❑Pressure ❑Equal via pressure g Z ../I I". ' (% <br /> Seri � <br /> • 7(ption lines construction material: <br /> Gravel and pipe_ ❑ Chamber ElTile ElPolystyrene foam and pipe ❑Other <br /> - • Absorption distribution (s): ❑dropbox❑hydrosplitter❑equal distribution box lam' 0 bOX c% 5 <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 />