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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. i_ I Permit Records r� Measured ^ -_Stamped on Tank j Other * Dosing tank material * Dosing tank appears to be watertight and in good condition Li Yes Ell No * Dosing tank lid is intact L__ j Yes i._-_..f No * Electrical components are sealed and watertight TI Yes ?__._ i No Pump/siphon is functional [ _i Yes El No * Type of Pump LT 1 Demand dose 1-__- J Time dose * Pump control mechanism is functional (floats,pressure transducer) Yes ! No ._ • * There is a high water alarm L j Yes 1 No * The high water alarm (audible and visual)is working L _I Yes L_. No L.i Not Applicable * Type of screen * Screen is clean and free of debris i_-_I Yes t____No * Screen cleaned for this evaluation I 1 Yes 4 No * Scum/sludge present in Dosing tank j Yes L___.. I No * 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 t_x_�Yes -�___, _ No Iy__I Unknown * Was the soil absorption system part of the evaluation? l x I Yes I 1 No ' 1 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 Lx]Equal C-r"Serial Pressure � {Equal via pressure * Absorption lines construction material: [-Xi Gravel and pipe _ (Chamber _ . ,Tile 1_.___1 Polystyrene foam and pipe i_ Other * Absorption distribution unit(s): ; .___]dropbox ~ hydrosplitter k xillequal distribution box 1��Intact i_ 1 Damaged L_ _i N/A * Absorption distribution unit(s)are free of debris or solids L x Yes ! INo 1-1N/A Page 4 of 8