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Oregon Department of Environmental Quality • Dosing tank capacity 6.-mt5r (gallons) • Tank volume determined by: Check all that apply,add comments below as needed �I;: 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 ` IYes ❑No • Pump/siphon is functional EYes ❑No • Type of Pump ®Demand dose ❑Time dose • Pump control mechanism is functional(floats,pressure transducer)VJYes ❑No • There is a high water alarm EYes ®No • The high water alarm(audible and visual)is working EYes ENo igNot Applicable • Type of screen (eic,2,i4-1.9 / $/0/c6 c • Screen is clean and free of debris EYes ❑No-Screen cleaned for this evaluationMYes ❑No • Scum/sludge present in Dosing tank ['Yes E1No • Scum layer (inches) Sludge layer (inches) • Additional Comments: L > r1 / C4 fr n p&ri i/ I-R i/b / R /iGw ,B�i.7Fnsi pOI�Gfrok_ Yv h /nShciirs, frviA rieW eicacZkil, h,il4wh1r A- fig ;2s //- by 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 D.Yes ❑No ❑Unknown • Was the soil absorption system part of the evaluation? I 'Yes ❑No OSee 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 ESerial ❑Pressure ►4Equal 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 igYes ONo ❑N/A Page 4 of 8