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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 El Permit Records El Measured❑ Stamped on Tank❑ Other • Dosing tank material • Dosing tank appears to be watertight and in good condition Dyes ❑No • Dosing tank lid is intact Dyes ❑No • Electrical components are sealed and watertight ❑Yes ❑No • Pump/siphon is functional Dyes ❑No • Type of Pump ['Demand dose ['Time dose • Pump control mechanism is functional(floats,pressure transducer)Dyes ❑No • Thereis a.high water alarm Dyes ❑No • The high water alarm(audible and visual)is working Dyes ❑No [Not Applicable • Type-of screen • Screen is clean and free of debris Dyes ['No-Screen cleaned for this evaluation❑Yes ❑No • Scum/sludge present in Dosing tank Dyes ❑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 lNYes ❑No ❑Unknown • Was the soil absorption system part of the evaluation? Wes ❑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 l ]Serial ['Pressure ['Equal via pressure • Absorption lines construction material: ❑Gravel and pipe ❑ Chamber ❑Tile El Polystyrene foam and pipe lI]Other Z • Absorption distribution unit(s): aldropbox❑hydrosplitter❑equal distribution box ( ]Intact El Damaged ❑N/A • Absorption distribution unit(s) are free of debris or solids R:1 Yes ❑No El N/A Page 4 of 8