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Oregon Department of Environmental Quality • Dosing tank capacity (gallons) • Tankvolurne determined by Check all that apply, add comments below as needed El Permit Records Measured 0 Stamped on Tank 0 Other • Dosing tank Material • Dosing tank appears to be watertight and.in good condition DYes ElNo • Dosing tank lid is intact Oyes 0No • Electrical components are sealed arid watertight DYes [No a Ptunp/siphonis fUnctional. • Type of Pump ODernandclOse ['Time dose • Pump control mechanism is functional(ficiats,pressure transducer)DYes ,ElNo • There is a high water alarm DYes EINo- • The high water alarm(audible and visual)is working EYes ,DNo [Not Applicable • Type of screen • Screen is clean and free of debris DYes ElNo-Screen cleaned for this evaluation Dyes ElNo • Scum/sludge present in Dosing tank Eyes [3Np • Scum layer (inches) Sludge layer (inches) • Additignal 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[171Yes ON° OUnknown • Was the soil absorption system part of the evaluation?['Yes 12:1No 0See note below If the soil absorption system was not evaluated,please explain below(for example unable to locate,client did not authorize this prof the evaluation) Client declined to have this part of the system evaluated at this tirna,Pkny following notes are based on the records and or field observations.at the time of theavaluation. • Absorption distribution ElEcntal ['Serial ['Pressure OEqual via presSure • Absorption lines construction material.: [I Gravel and pipe El Chamber El Tile 1:1 Polystyrene foam and pipe ['Other • Absorption distribution unit(s):Edropbox Dhydrosplitter Dequal distribution box [1 Intact D Damaged EJNIA • Absorption distribution unit(s)are free of debris or solids ['Yes :No 0 N/A Page 4 of 8