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Oregon Department of Environmental Quality • Dosing tank capacity Smm (gallons) • Tank volume determined by: Check all that apply,add comments below as needed r,;1 Permit Records❑Measured❑ Stamped on Tank❑Other • Dosing tank material Oc?c er..v. • Dosing tank appears to be watertight and in good condition EYes ❑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)V]Yes ❑No • There is a high water alarm['Yes No Pes�/eze.,/n/=�- • The high water alarm(audible and visual)is working ❑Yes ❑No EINot Applicable • Type of screen „o// e / $/p/cts c • Screen is clean and free of debris Yf Yes ❑No-Screen cleaned for this evaluation,EYes ❑No • Scum/sludge present in Dosing tank ['Yes No • Scum layer (inches) Sludge layer (inches) • Additional Comments: W19 ) on /erM i r /"r 2 V �z/ R i7C ��' ' PO ��0/G 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? I!: 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 ElEqual via pressure • Absorption lines construction material: F.2 Gravel and pipe ❑Chamber ❑Tile ❑Polystyrene foam and pipe ❑Other • Absorption distribution unit(s): ❑dropbox❑hydrosplitter❑equal distribution box ❑Intact ❑Damaged tid N/A • Absorption distribution unit(s)are free of debris or solids Yes ❑No ❑N/A Page 4 of 8