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• Oregon Department of Environmental Quality * Dosing tank capacity 500 (gallons) * Tank volume determined by:Check all that apply,add comments below as needed. x Permit Records x Measured Stamped on Tank Other * Dosing tank material CONCRETE * Dosing tank appears to be watertight and in good condition x Yes No * Dosing tank lid is intact Yes x No * Electrical components are sealed and watertight x Yes No * Pump/siphon is functional x Yes No * Type of Pump x Demand dose Time dose * Pump control mechanism is functional(floats,pressure transducer) x Yes No * There is a high water alarm _ x Yes No * The high water alarm(audible and visual)is working Yes x No Not Applicable * Type of screen BIO FILTER * Screen is clean and free of debris x Yes Fig * Screen cleaned for this evaluation x Yes No * Scum/sludge present in Dosing tank x j Yes No * Scum layer 0 (inches) Sludge layer 3 (inches) * Additional Comments: NO WATER OR POWER AVAILABLE. USED GENERATOR TO TEST ELECTRICAL COMPONENTS.LID, RISER, DISCHARGE,AND ELECTRICAL ALL NEED REPLACED FOR THE DOSING TANK.SEE ATTACHED PICTURES 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 xI Yes No Unknown * Was the soil absorption system part of the evaluation? x 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 x Equal via pressure * Absorption lines construction material: x Gravel and pipe Chamber }Tile Polystyrene foam and pipe Other * Absorption distribution unit(s): dropbox hydrosplitter equal distribution box Intact Damaged x N/A * Absorption distribution unit(s)are free of debris or solids l Yes No x N/A Page 4 of 8