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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 D Measured 0 Stamped on Tank 0 Other • Dosing tank material • Dosing tank appears to be watertight and in good condition OYes ONo • Dosing tank lid is intact OYes ONo • Electrical components are sealed and watertight OYes ONo • Pump/siphon is functional OYes ONo • Type of Pump. ODemand dose OTime dose • Pump control mechanism is functional(floats,pressure transducer)OYes ONo • There is a high water alarm[Yes ONo • The high water alarm(audible and visual)is working OYes ONo ONot Applicable • Type of screen • Screen is clean and free of debris Oyes ONo-Screen cleaned for this evaluation 0Yes 10No • Scum/sludge present in Dosing tank 0Yes ONo • 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 RlYes ON0 OUnknown • Was the soil absorption system part of the evaluation?gaYes ONo 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 0Equal OSerial OPressure 0Equal via pressure • Absorption lines construction material: O Gravel and pipe 0 Chamber IJ Tile EI Polystyrene foam and pipe 00ther • Absorption distribution unit(s):Odropbox Ohydrosplitter gequal'distribution box 0 Intact 0 Damaged 0 N/A • Absorption distribution unit(s)are free of debris or solids Oyes 0No 0 N/A Page 4 of 8