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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❑ Other • Dosing tank material • Dosing tank appears to be watertight and in good condition EYes No • Dosing tank lid is intact EYes ❑No • Electrical components are sealed and watertight EYes No • Pump/siphon is functional EYes No • Type of Pump ❑Demand dose ❑Time dose • Pump control mechanism is functional(floats,pressure transducer)EYes ❑No • There is a high water alarm EYes No • The high water alarm(audible and visual)is working EYes ❑No ❑Not Applicable • Type of screen • Screen is clean and free of debris EYes ❑No-Screen cleaned for this evaluation EYes ❑No • Scum/sludge present in Dosing tank EYes ❑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 EYes ❑No ❑Unknown • Was the soil absorption system part of the evaluation?EYes ❑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): • 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 Ehydrosplitter❑equal distribution box ❑Intact ❑Damaged ❑N/A • Absorption distribution unit(s)are free of debris or solids EYes ❑No ❑N/A Page4of8 _