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