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' I Oregon Department of Environmental Quality • Dosing tank capacity (gallons) • Tank volume determined by: Check all that apply,add comments belo as needed 0 Permit Records❑Measured❑Stamped on Tank❑Other • Dosing tank material • Dosing tank appears to be watertight and in good condition ❑Yes No • Dosing tank lid is intact ❑Yes ONo • Electrical components are sealed and watertight Yes gh ❑ ONo • Pump/siphon is functional [(Yes ONo • Type of Pump ❑Demand dose ['Time dose • Pump control mechanism is functional (floats,pressure transducer)❑ es ONo • There is a high water alarm❑Yes ONo • The highwater alarm(audible and visual) working is i❑Yes ONo ■Not Applicable • Type of screen • Screen is clean and free of debris❑Yes ONo-Screen cleaned for thi:evaluation❑Yes ❑No • Scum/sludge present in Dosing tank ❑Yes 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 fro'u the septic tank and filters the effluent before it enters the groundwater. • The septic system has a soil absorption system ®Yes ONo ❑Unkno n • Was the soil absorption system part of the evaluation?❑Yes No ■See note below If the soil absorption system was not evaluated,please explain belo (for example unable to locate,client did not authorize this part of the evaluation): The county did not require the soil absorption area to be part of the evaluation. • Absorption distribution ❑Equal ❑Serial ❑Pressure ['Equal via •ressurc • Absorption lines construction material: ❑Gravel and pipe 0 Chamber 0 Tile 0 Polystyrene foam and pipe II Other • Absorption distribution unit(s): ❑dropbox Ohydrosplitter❑equal dis'ibution box ❑Intact ❑Damaged ❑N/A • Absorption distribution unit(s)are free of debris or solids ❑ ❑N• 0 Yes • N/A Page 4 of 8