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- r <br /> ' f <br /> 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 /> 0 Permit Records 0 Measured 0 Stamped on Tank❑Other <br /> • Dosing tank material <br /> • Dosing tank appears to be watertight and in good condition ❑Yes ONo <br /> • Dosing tank lid is intact ❑Yes ONo <br /> • Electrical components are sealed and watertight ❑Yes ONo <br /> • Pump/siphon is functional ❑Yes ONo <br /> • Type of Pump ❑Demand dose ❑Time dose <br /> • Pump control mechanism is functional(floats,pressure transducer)❑Yes ONo <br /> • There is a high water alarm['Yes ONo <br /> • The high water alarm(audible and visual)is working ❑Yes ONo ONot Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris❑Yes ONo-Screen cleaned for this evaluation❑Yes ONo <br /> • Scum/sludge present in Dosing tank ❑Yes ONo <br /> • Scum layer (inches) Sludge layer (inches) <br /> • Additional Comments: <br /> 5. Soil absorption system <br /> The soil absorption system isa 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 ONo ['Unknown <br /> • Was the soil absorption system part of the evaluation?lYes ONo OSee 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 mSerial ['Pressure ❑Equal via pressure <br /> • Absorption lines construction material: <br /> 0 Gravel and pipe ❑Chamber ❑Tile ❑Polystyrene foam and pipe ❑Other <br /> • Absorption distribution unit(s):mdropbox❑hydrosplitter❑equal distribution box <br /> VI Intact ❑Damaged ❑N/A <br /> • Absorption distribution unit(s)are free of debris or solids OYes ONo 0 N/A <br /> Page4of8 <br /> - i <br /> 5 <br />