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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 ['Yes No • Dosing tank lid is intact [Yes ['No • Electrical components are sealed and watertight ❑Yes ❑No • Pump/siphon is functional [Yes [No • Type of Pump ❑Demand dose ['Time dose - • Pump control mechanism is functional (floats,pressure transducer)['Yes [No • There is a high water alarm❑Yes [No • The high water alarm(audible and visual)is working EYes ❑No ['Not Applicable • Type of screen • Screen is clean and free of debris['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 ►_+ es ❑No ['Unknown • Was the soil absorption system part of the evaluation?['Yes glo [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❑hydrosplitter[equal distribution box ❑Intact ❑Damaged ❑N/A • Absorption distribution unit(s)are free of debris or solids ❑Yes ❑No❑N/A Page 4 of 8