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• Oregon llepaitment of Environmental Quality • Dosing tank capacity (gallons) • Tank volume determined by:Check all that apply,add comments below as needed 0 Permit Records 0 Measured 0 Stamped on Tank 0 Other • Dosing tank material • Dosing tank appears to be watertight and in good condition DYes ONo • Dosing tank lid is intact DYes DNo • Electrical components are sealed and watertight :Wes ONo • Pump/siphon is functional DYes DNo • Type of Pump 0Demand dose. 0Time dose • Pump control mechanism is functional(floats,pressure transducer)DYes DNo • There is a higb water alarm 0Yes DNo • The high water alarm(audible and visual)is working :Wes DNo 0Not Applicable • Type of screen • Screen is clean and free of debris DYes ONo-Screen cleaned for this evaluation Dies ONo. • Scum/sludge present in Dosing tank DYes DNo • 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 gRes ONo ['Unknown • Was the soil absorption system part of the evaluation?0Yes 0No ['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 0Equal 0Serial OPressure °Equal via pressure • Absorption lines construction material: 0 Gravel and pipe 0 Chamber 0 Tile 0 Polystyrene foam and pipe 00ther Corrigaled pipe • Absorption distribution unit(s):Ddropbox Dhydrosplitter[Thqual distribution box LZI Intact El Damaged 0 N/A • Absorption distribution unit(s)are free of debris or solids 01/es 0No El N/A Page 4 of 8