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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 , Measured : :Stamped on Tank I Other * Dosing tank material * Dosing tank appears to be watertight and in good condition ( 1 Yes 1, No • * Dosing tank lid is intact •Yes _ No * Electrical components are sealed and watertight Yes • No * Pump/siphon is functional Yes I No * Type of Pump Demand dose I j Time dose • Pump control mechanism is functional(floats,pressure transducer) j I Yes ;No * There is a high water alarm _y Yes j No * The high water alarm(audible and visual)is working j Yes ! ;No ! !Not Applicable * Type of screen * Screen is clean and free of debris I Yes No * Screen cleaned for this evaluation • Yes No * Scum/sludge present in Dosing tank • •Yes !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 1 Yes !No : x Unknown * Was the soil absorption system part of the evaluation? 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): CUSTOMER DID NOT AUTHORIZE * Absorption distribution Equal Serial • Pressure Equal via pressure * Absorption lines construction material: • !Gravel and.pipe Chamber !Tile Polystyrene foam and pipe Other * Absorption distribution unit(s): dropbox hydrosplitter 'equal distribution box Intact Damaged • N/A * Absorption distribution unit(s)are free of debris or solids Yes 1No N/A Page 4 of 8