Evaluation Report Format

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(Gals/in): Liquid Level Differential (in): Dose Vol (Gals): Dose Tank 1 Dose Tank 2 PUMPS Design Pump Run Time/Dose: Design Doses/Day: Design Recirculation Ratio: TREATMENT PROCESS TYPES (circle appropriate process) Septic Tank S/T Effluent Filter S/T Trickling Filter Aerobic Unit ISF RSF Packed Media Filter AnoxiBioFilter Denitrofication Unit Other TREATMENT PROCESS SIZING Filter Surface Area (SF): Filter Hydraulic Design Rate (G/D/SF): DISTRIBUTION NETWORK (circle appropriate method) Gravity: Parallel Serial Unequal or Pressure Distribution: Residual Pressure: 1 2 3 4 5 6 Treatment Unit: Absorption Unit: Soil Absorption Media: (circle appropriate type) Gravel Chamber Geotextile Peat Large Dia.Pipe Styrofoam Hydrospliter 7 8 Drip Emitters 9 10 NON-STANDARD SYSTEM Site: Date of Inspection: Actual Flow (G/D): OPERATION MONITORING DATA APN: Occupant Name: Recorder: Occupants Basis of Actual Flow: TREATMENT UNIT Operating Liquid Depth (in): Effluent Filter Condition Scum Depth (in): Sludge Depth (in): PUMPS Dose Tank 1 Pump Run Time/Day: Doses/Day: Pump Run Time/Dose: Actual Filter Hydraulic Rate (G/D/SF): Recirculation Ratio: DISTRIBUTION NETWORKS Residual Pressure: 1 2 Treatment Unit: Absorption Unit: 3 FILTER OPERATION Media Surface Ponding Riser 1 Filter Effluent Sample Parameters: BOD 4 Dose Tank 2 5 2 TSS 6 7 3 FC SOIL ABSORPTION Actual Soil Loading Rate (G/D/SF): Monitoring Wells Depth to Groundwater (in): Upslope 1 Upslope 2 Downslope 3 Downslope 4 Trench Ponding (in): 1 2 3 4 5 6 7 COMMENTS Liquid Level Alarms Operating Effluent Clarity/Odor Soil Absorption Unit: Selective Fertility Hydrophilic Vegetation Erosion Curtain Drain Outlet Visible Discharging U: Report Format Site Evaluation Report Form.wpd 8 9 10 4 NO3 8 Downslope 5 9 10 MENDOCINO COUNTY Environmental Health Pump Meter Data Owner Name: Site Address: APN: Recorded by: Pump Tank Type: Date WATER METER 99/x x day s mete r )gal TIMER METER G/D U: Report Format Site Evaluation Report Form.wpd mete r

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