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• �• 1 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 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 x Yes No i * 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 x Yes No Not Applicable * Type of screen BIOFILTER * Screen is clean and free of debris x Yes (Vo * Screen cleaned for this evaluation x Yes No * Scum/sludge present in Dosing tank x Yes No * Scum layer 4 (inches) Sludge layer 3 (inches) * Additional Comments: TESTED ELECTRICAL COMPONENTS WITH GENERATOR. 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 x Yes No Unknown * Was the soil absorption system part of the evaluation? x Yes L I No See note below If the soil absorption system was not evaluated,please explain be ow for example unable to locate,client did not authorize this part of the evaluation): * Absorption distribution n Equal riSerial 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 1Yes No x N/A Page 4 of 8