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Oregon Department of Environmental Quality • Dosing tank capacity .• Tank:volume determinedhy: Check all that apply,add co . ii cuts below as needed El Permit Records El Measured 0 Stamped on Tank.12 Other, • Dosing tank material ,,Ai Ilir• Dosing tank appears to be watertight and in good condition 0Yes ONo • Dosing tank lid is intact 0Yes ONo -•- Electrical components are sealed and watertight :Yes: LIN° • Pimp/siphon is finictional 0Yes [!6-No • Type of Pump 0Demand dose OTime dose : - • Pump control mechanism-is-functional loins,pmssure transducer)0Yes ONo • There is a high water alarm 0Yes : o , . , • The high water alarm(audible and visual)is working 0Yes 1fNo ONot Applicable * Type of screen,i)0\ . ,..m.t.,.5 in ., , . . :Screen,is clean and M. of debris 0Yes No-Screen cleaned for this evaluation ElYes No • Scum/sludge present in Dosing tank 0Yes []No ' , • , Scum layer (inches) Sludge layer (inches) • - •- Additional Conunents: • - , 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 einem the groundwater • The septic system has a soil abserption systein N't... ONo 0 - min • Was the soil absorption system part of the evaluation?0Yea o 1-11 Sec note below If the soil absorption System waikriot evaluated please explain below(for eitample unable to locate,elient did not authorize this purl of the evaluation): ppitervrtMftet6 t, 1,,,,,t- 40 n- -.i. . 40 vutzd• Litiv ,-..s prop-t-elt) .44 . . • Absorption distrihution 0Equal OSerial,OPressUre [jape!viapressure.i 12 ' ,.., • sorption lines construction material: Gravel and pipe 0 Chamber 0 Tile El Polystyrene foani and pipe :10thtz • Absorption distribution unit(s): Odruphox Ohydrosplitter 0equal distribution box .. . . El intact [1)Daniagoci D N/A _ .. • Absorption distribution unit(s)are free of debris or solids Dies Et:No 0 N/A ... • ... Page 4 of 8