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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 1 Stamped on Tank , Other * Dosing tank material * Dosing tank appears to be watertight and in good condition Yes I = 1 No * Dosing tank lid is intact Yes I 1 No * Electrical components are sealed and watertight 1 Yes 1 1 No * Pump/siphon is functional 1 .Yes l No * Type of Pump j Demand dose Time dose * Pump control mechanism is functional (floats,pressure transducer) n Yes n No * There is a high water alarm ;Yes 1 No The high water alarm(audible and visual)is working Yes I No ~Not Applicable * Type of screen * Screen is clean and free of debris Yes No * Screen cleaned for this evaluation 111 Yes i I No I * Scum/sludge present in Dosing tank 1 Yes I 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 x Yes ! No Unknown * Was the soil absorption system part of the evaluation? I x Yes 1 No I I 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): r--I * Absorption distribution ' x!Equal 1 Serial Pressure 1 Equal via pressure * Absorption lines construction material: x i Gravel and pipe Chamber Tile 9 1 Polystyrene foam and pipe 1 `Other * Absorption distribution unit(s): dropbox hydrosplitter1 x ;equal distribution box x Intact Damaged N/A * Absorption distribution unit(s)are free of debris or solids Des CNo jN/A Page 4 of 8