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Oregon Department of Environmental Quality • Dosing tank capacity 1000 (gallons) • Tank volume determined by: Check all that apply,add comments below as needed ❑ Permit Records 0 Measured❑ Stamped on Tank❑ Other • Dosing tank material Concrete • Dosing tank appears to be watertight and in good condition DYes ❑No • Dosing tank lid is intact :Wes ❑No • Electrical components are sealed and watertight EYes DNo • Pump/siphon is functional ❑x Yes ❑No • Type of Pump ❑x Demand dose ❑Time dose • Pump control mechanism is functional(floats,pressure transducer)EYes ❑No • There is a high water alarm['Yes DNo • The high water alarm(audible and visual)is working ❑Yes ONO ENot Applicable • Type of screen basket screen • Screen is clean and free of debris EYes ❑No-Screen cleaned for this evaluation❑Yes ONo • Scum/sludge present in Dosing tank EYes ❑No • Scum layer 0 (inches) Sludge layer 4 (inches) Total Liquid Depth 48" • Additional Comments: Recommend installing high level alarm. 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['Yes ❑No ['Unknown • Was the soil absorption system part of the evaluation?[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 DEqual ❑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 ENo❑N/A Page 4 of 8