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Oregon Department of Environmental Quality ' Dosing tank capacity 500 (gallons) * Tank volume determined by:Check all that apply,add comments below as needed. x Permit Records Measured Stamped on Tank Other * Dosing tank material CONCRETE ' Dosing tank appears to be watertight and in good condition x Yes No • Dosing tank lid is intact x Yes No • Electrical components are sealed and watertight x Yes No ' Pump/siphon is functional x Yes No ' Type of Pump x Demand dose Time dose • Pump control mechanism is functional(floats,pressure transducer) Yes x No • There is a high water alarm Yes x No • The high water alarm(audible and visual)is working Yes No x Not Applicable ' Type of screen NO SCREEN • Screen is clean and free of debris x Yes No • Screen cleaned for this evaluation Yes x No • Scum/sludge present in Dosing tank x Yes No • Scum layer 0 (inches) Sludge layer <1 (inches) ' Additional Comments: HOUSE WAS BURNT DOWN IN WILDFIRES.PANEL BURNT UP IN THE WILDFIRES AS WELL. 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 Unknown * Was the soil absorption system part of the evaluation? x Yes 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 x Equal via pressure * Absorption lines construction material: Gravel and pipe Chamber Tile Polystyrene foam and pipe x Other ' Absorption distribution unit(s): dropbox hydrosplitter equal distribution box Intact Damaged x N/A • Absorption distribution unit(s)are free of debris or solids Yes No x N/A Page 4 of 8