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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 DYes ❑No <br /> • Dosing tank rd is intact ['Yes •No <br /> • Electrical co . I ents . e seal..I and watertight ['Yes Digo <br /> • Pump/sipho i cti. . IIYes o <br /> • Type of Pum! ❑n e. : . .ose ❑T a dose <br /> • Pump control .ech. m i• functio oats,pressure transducer)EYes ❑No <br /> • There is a hip water al. DYes <br /> • The high water alarm(. alible and sual)is working ['Yes ❑No ❑Not Applicable <br /> • Type of screen <br /> • Screen is clean and free of debris EYes ❑No-Screen cleaned for this evaluation Eyes ❑No <br /> • Scum/sludge present in Dosing tank DYes ❑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_Yes ❑No ❑Unknown <br /> • Was the soil absorption system part of the evaluation?a iYes 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 distribution R1Equal ['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 tyequal distributionI , box <br /> El IntactIZ <br /> Damaged E N/A ,gfe4r., c -dc ocx wrM NEI,.) M ray...( <br /> • Absorption distribution unit(s)are free of debris or solids Yes ❑No❑N/A <br /> Page 4 of 8 <br />