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• Oregon Department of Environmental Quality • • Dosing tank capacity (gallons) • Tank volume determined by:Check all that apply,•add comments below as needed ❑Permit Records.0 Measured❑Stamped on Tank❑Other • posing tank material • Dosing tank appears to be watertight and in good condition ['Yes ❑No • Dosing tank lid is intact ['Yes ❑No • l lectrical..components are sealed and watertight DYes ❑No • • • • Pump/siphon is functional DYes ❑No • • Type of pump ['Demand dose ['Time dose • Pump control mechanism is functional(floats,pressure transducer)['Yes ONO . • There is a high water alarm❑yes ❑No • The high water alarm(audible and visual)is working ['Yes ❑No [Not Applicable • Type of screen • Screen is clean and free of debris DYes ONO-Screen cleaned for this evaluation['Yes ❑No • Scum/sludge present in Dosing tank DYes ['No • Scum layer i (inches) Sludge layer. (inches) • Additional Comments: • • 5. Soil absorption system The soil absorption system is a set of trenches that receives effluent from the septic tank and filters the effluent before it enters the groundwater. • The septic system has a soil absorption system JSYes [No DUnknown • Was the soil absorption system part of the evaluation?Ares ❑No ['See note below If the soil absorption system was not evaluated;please explain below(for example unable to locate,client did not authorize this part of the evaluation): • • Absorption distribution Weal ['Serial ['Pressure DEqual via pressure • Absorption lines construction material: • XGravel and pipe ❑Chamber ❑Tile ❑Polystyrene foam and pipe ['Other • Absorption distribution unit(s):Ddropbox Dhydrosplitter Aqual distribution box ❑Intact ❑Damaged .N/A• • Absorption distribution units)are free of debris.or solids ['Yes ❑No_01N/A Page 4 6f 8 .