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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❑Measured❑ Stamped on Tank❑ Other • Dosing tank material • Dosing tank appears to be watertight and in good condition ❑Yes ❑No • Dosing tank lid is intact ['Yes ❑No • Electrical components are sealed and watertight ❑Yes ❑No • Pump/siphon is functional ❑Yes ❑No • Type of Pump ['Demand dose ❑Time dose • Pump control mechanism is functional(floats,pressure transducer) ['Yes No • 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❑Yes ❑No-Screen cleaned for this evaluation❑Yes ❑No • Scum/sludge present in Dosing tank ❑Yes ❑No • Scum layer (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©Yes ❑No ❑Unknown • Was the soil absorption system part of the evaluation?©Yes ❑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 ✓❑Equal ❑Serial ❑Pressure ['Equal via pressure • Absorption lines construction material: ✓❑ Gravel and pipe ❑ Chamber ❑Tile ❑Polystyrene foam and pipe ❑Other • Absorption distribution unit(s): ❑dropbox❑hydrosplitter ✓❑equal distribution box ©Intact ❑Damaged ❑N/A • Absorption distribution unit(s)are free of debris or solids ❑✓Yes ❑No El N/A Page 4 of 8